TUFTS    UNIVEHSI 


9090  014   532  408 


Webstsr  hamiiy  Library  of  Veterinary  Uddloau 
Cummings  School  of  Veterinary  IVledicine  at 
Tufts  University 
200  Westboro  Road 
North  Grafton,  MA  01536 


IVIANUAL 

OF 


OPERATIVE  VETERINAfiy  SURtEl!!, 


BY 


A.  LIAUTARD,  M.D.,  V.M. 

Principal  and  Professor  of  Anatomy,  Surgery,  Sanitary  Med- 
icine AND  Jurisprudence  in  the  American  Veterinary  Col- 
lege ;   Chevalier  du  Merite  Agricole  de  France  ;  For- 
eign Corresponding  Member  of  the  Societe  Cen- 
trale  de  Medi^cine  Veterinaire  (Paris);  Hon- 
orary Fellow  of  the  Royal  College  of 
Veterinary  Surgeons  (London);  Hon- 
orary  Member  of   the   Societe 
Veterinaire   d' Alsace-Lor- 
raine, Etc.,  Etc.,  Etc. 

Author  of  '-'Fade  Mecum  of  Equine  Afiatofny /'    ''How  to   Tell 
the  Age  of  Domestic  Animals  •'''    "-Animal   Castration ;'' 
'•'•Lameness  of  Horses ;'    Translator  of  "•  Bouley 
on  Hydrophobia  r  of '■'■  Zundel  ofi  Diseases 
of  the  Foot;''''   Editor  of  the  ''■Ameri- 
can Veterinary  Review?^ 


WITH    NEARLY   600  ILLUSTRATIONS. 


NEW    YORK 
WILLIAM    R.    JENKINS 

VETERINARY  PUBLISHER  AND  BOOKSELLER 

851  AND  S53  Sixth  Avenue 


-52 
8^1 


COPYRIGHTED,   1891, 

By  a.  Liautard,  M.D.,  V,M. 
All  Rights  Reserved. 


TO 


Dr.    a.    CHAUVEAU, 

Member  of  the  Institute  (Paris'),  General  Inspector  of  tJie  Veterinary  Schools 
{France),  Professor  to  the  Museum  of  Nattiral  History  (Paris), 

As  a  humble  token  of  the  high  appreciation  of  his  scientific  labors 
in  behalf  of  Veterinary  and  Comparative  Medicine,  this  work  is,  with 
kind  permission,  dedicated  by 

THE  AUTHOR. 


PREKACK. 


If  an  apology  should  be  deemed  necessary  for  any  apparent  tardiness 
in  the  execution  of  the  special  undertaking  of  which  the  present  work  is 
the  result,  it  will  not  be  very  far  to  seek,  but  may  be  readily  found  by  a 
reference  to  the  various  and  unceasing  vocations  in  which  the  author  of 
the  Manual  of  Operative  Veterinary  Surgery  is  habitually  engaged. 
The  labor  of  its  preparation  has,  in  fact,  been  alternated  and  shared  with 
that  of  other  literary  engagements  of  an  imperative  and  unremittent  char- 
acter, and  the  onerous  and  exhaustive  duties  pertaining  to  his  collegiate 
functions,  to  say  nothing  of  the  demands  of  an  extensive  practice. 

Engaged  for  years  in  the  work  of  teaching  this  special  department  of 
veterinary  medicine,  and  having  abundant  opportunities,  which  have  not 
been  neglected,  of  realizing  the  difficulties  which  the  student  who  earnestly 
strives  to  perfect  himself  in  his  calling  is  obliged  to  encounter,  I  formed 
the  determination  long  since  to  do  what  lay  in  me  to  facilitate  his  acquisi- 
tion of  knowledge;  and  it  was  then  that  I  projected  the  present  volume, 
and  began  the  accumulation  of  material  by  the  compilation  of  data  and 
arrangement  of  memoranda,  with  the  recorded  notes  of  my  own  experi- 
ence, the  fruit  of  a  long  and  extended  practice  before  referred  to ;  and  of 
course  a  careful  study  of  the  various  authorities  who  have  illustrated  and 
organized  our  copious  veterinary  literature.  Moreover,  haste  in  the  pub- 
lication, and  a  thorough  digestion  of  the  subject  and  the  systematic  order- 
ing of  material,  could  not  be  very  easily  combined,  and  a  little  delay  in 
the  issue  will  prove  no  detriment  to  the  value  of  the  book. 

With  his  own  kind  permission,  the  work  is  dedicated  to  Professor 
A.  Chauveau,  General  Inspector  of  the  Veterinary  Schools  of  France,  as  a 
token  of  my  high  appreciation  of  his  services  as  a  scientist,  and  in  recog- 
nition of  his  standing  among  the  lights  of  our  profession ;  and  especially 
of  ray  estimation  of  his  excellent  book  on  anatomy,  in  which  he  so  ably 
lays  the  foundation  of  the  knowledge  which  constitutes  the  indispensable 
condition  of  all  success  in  surgical  practice. 


I  have  been  liberal  with  European  authors,  not  only  in  freely  cred- 
iting them  with  their  discoveries  and  theories,  and  in  many  cases  quoting 
literally  their  opinions  and  arguments,  but  especially  so  in  adopting  their 
illustrations  and  enriching  the  work  with  the  artistic  representations  orig- 
inating in  their's— an  emphatic  manifestation  of  my  high  estimate  of  their 
value  and  the  skill  of  their  execution.  And  it  is  thus  that  the  names  and 
accomplishments  of  Rigot,  Bouley,  Qourdon,  Peuch,  Toussaint,  Cadiot 
and  Zundel,  of  France ;  of  Brogniez  and  Degives,  of  Belgium ;  of  Hert- 
wig,  Hering,  Moller  and  Hoffman,  of  Germany;  of  Lanzillotti-Buonsanti. 
of  Italy;  and  of  Williams  and  Fleming,  of  England,  will  become  famil- 
iarly known  to  our  readers. 

But  while  I  have  in  great  part  been  guided  in  my  work  by  the  char- 
acter  of  that  of  our  predecessors,  I  have  not  restricted  myself  to  the 
lines  observed  by  them,  or  exclusively  respected  the  authority  or  prece- 
dents of  European  surgeons,  but  have  sought  to  do  justice  to  the  progress 
of  American  veterinarians  by  honoring  the  contributions  they  have  made 
to  our  surgical  knowledge ;  and  it  is  due  to  accident  alone,  and  to  no  in- 
vidious design,  if  any  omission  or  oversight  has  been  committed,  by  which 
any  to  whom  credit  should  be  awarded  have  failed  to  receive  it. 

The  chapters  of  the  Manual  which  treat  respectively  upon  "Frac- 
tures" and  upon  "Operations  on  the  Foot"  are  reprinted  from  my  own 
previous  writings.  Thus,  in  the  first  instance,  the  remarks  upon  frac- 
tures, with  the  kind  permission  of  the  Hon.  Jeremiah  M.  Rusk,  Secretary 
of  the  Department  of  Agriculture,  are  extracted  from  an  article  published 
in  "  The  Special  Report  on  Diseases  of  the  Horse;"  and  in  the  second  in- 
stance, touching  the  subject  of  operations  on  the  foot,  I  have  not  hesitated 
to  utilize  my  own  translation  of  Zundel,  produced  as  long  ago  as  the  year 
1881.  In  both  cases  improvement  has  been  made  upon  the  previous  treat- 
ment of  these  topics  by  the  addition  of  numerous  illustrative  plates  which 
accompany  the  text. 

In  the  chapter  upon  operations  on  the  genito-urinary  apparatus  the 
reader  is  referred  to  my  special  work  on  the  subject  of  "  Castration," 
which  is  not  included  in  the  present  volume. 

In  completing  the  task  undertaken  in  the  preparation  of  the  Manual, 
however  perfect  or  imperfect  may  be  the  manner  of  its  execution,  while 
I  have  been  influenced  by  a  desire  to  effect  something  for  the  benefit  of 
all  classes  of  practitioners,  including  those  of  recent  graduation,  my  ob- 
ject above  all  has  been  to  facilitate  the  labors  of  the  young  student  while 
industriously  and  anxiously  toiling  for  the  knowledge  which  is»  to  qualify 


him  for  a  successful  career  in  a  useful  and  honorable  profession ;  and  if 
I  shall  have  succeeded  in  this  object,  and  the  success  shall  be  certified  by 
the  verdict  yet  to  be  pronounced,  I  shall  feel  fully  satisfied  and  more  than 
ever  encouraged  to  persevere  in  my  efforts  to  elevate  the  standard  of  vet- 
erinary science  in  America. 

No  toil  has  been  spared,  no  effort  relaxed,  in  the  prosecution  of  the 
design  and  desire  to  compel  the  approval  of  the  judicious,  and  even  to 
escape  the  strictures  of  the  critical,  and  I  have  not  failed  to  seek  for  aid 
and  counsel  from  competent  coadjutors.  The  entire  text  has  undergone 
revision,  with  a  view  to  the  improvement  of  its  idiomatic  structure,  by  my 
esteemed  friend,  H.  D.  Holt,  M. D.,  of  Jersey  City,  N.  J.,  to  whom  I  am 
also  indebted  for  the  favor  of  supervising  the  proof  and  overlooking  the 
issue  and  arrangement  of  the  various  chapters;  and  my  publisher  has 
exercised  a  true  liberality  in  providing  an  external  garment  and  garni- 
ture for  the  contents  of  the  book,  in  all  respects  correspondent  with 
their  value  and  interest.  To  that  gentleman,  therefore,  are  due  my 
warmest  acknowledgments  for  whatever  of  internal  and  external 
attractiveness  may  characterize  the  Manual  of  Operative  Veterinary 
Surgery,  and  they  are  cordially  and  freely  tendered. 

I  have  now  only  to  express  the  hope  that  this  contribution  to  the 
cause  of  veterinary  progress  may  be  as  kindly  received  and  favorably 
judged  by  my  colleagues  as  it  is  honestly  designed  to  effect  its  object  by 
me,  and  that  any  shortcomings  in  the  execution  of  the  work  may  be  len- 
iently regarded.  And  so  it  goes  into  the  hands  of  the  public,  to  share  the 
fate  of  all  human  ventures,  for  better  or  for  worse,  as  its  fate  may  be. 

THE  AUTHOR. 


CONTENTS. 


PAGE. 

Intkoduction 1 

CHAPTER  I. 

Means  of  Restraint 14 

Means  of  Securing  Solipeds 14 

Derivative  or  Painful  Method 14 

Mechanical  or  Restraint  Method 17 

Standing  Position 17 

Recumbent  Position 27 

Casting  with  Hobbles 30 

Securing  the  Legs 38 

Casting  with  Ropes  44 

Casting  on  the  Operating  Tables 47 

Means  of  Securing  other  Domestic  Animals 54 

Bovines '. 54 

Ovines  and  Caprines  62 

Swine     62 

Dogs  and  Cats 64 

Stjrgioal  Anesthesia 66 

Local  Anesthesia 67 

General  Anesthesia 70 

Accidents  of  General  Anesthesia. 75 

Accidents  Incidental  to  the  use  of  means  of  Restraint 76 

Fractures 76 

Injuries  of  Soft  Tissues 79 

CHAPTER  II. 
Stjegioal  Diagnosis. 

Sight 81 

Touch 86 

Hearing  88 

Smell 88 

Taste 88 


X  CONTENTS. 

CHAPTER  III. 
Surgical  Therapeutics.  page. 

Dressings 90 

Retentive  Dressing 98 

Uniting  " 99 

Suspensory    "  99 

Compressive  Dressing 99 

Dividing  Dressing 99 

Expulsive      "     ,    99 

Antiseptic     "  100 

Bandages 103 

Varieties  of  Bandages 105 

CHAPTER  rV. 

Elementary  Operations. 

Division 125 

Incisions 125 

Dissections 137 

Puncture 138 

Reunion 142 

Position        144 

Uniting  Bandages 144 

Sutures 146 

CHAPTER    V. 
Operations  on  the  Skin  and  Cellular  Tissue. 

Cauterization 158 

Actual  Cauterization  or  Firing 158 

Transcurrent  or  Firing  iu  Lines 160 

Firing  on  the  Surface  or  "  a  la  Gaulet " 171 

Firing  in  Superficial  Points 172 

Objective  Firing 174 

Deep  Cauterization 175 

Rapid,  Deep  Cauterization 175 

Inherent  Firing 178 

Subcutaneous  Cauterization 180 

Cauterization  with  the  Thermo-Cautery 182 

Cauterization  in  other  Animals 183 

Accidents  of  Actual  Cauterization 184 


CONTENTS.  H 

Operations  on  the  Skin  and  Cellular  Tissue — Continued.  page. 

Exutories 186 

Setons 188 

Tape  Seton 188 

Regions  to  apply  Setons 193 

Rowel  Seton 197 

Trochiscus 198 

Accidents  or  Sequelae  of  Setons 198 

Ablation  of  Tumors 200 

Excision 201 

Ligature 205 

Elastic  Ligature 210 

Removal  by  Tearing 211 

Puncture 211 

CHAPTER  VI. 
Opbeations  on  Bones. 

Fractures.     (Generalities) 212 

Fractures  of  Different  Bones 229 

Dislocations 262 

Amputations 266 

Amputation  of  Members 268 

"          "    Horns, 2T4 

"    the  Tail 277 

Trephining 283 

Periostotomy 291 

Resection  of  Bones 293 

CHAPTER  Vn. 

Operations  on  Muscles  and  their  Annexes. 

Caudal  Myotomy 296 

Caudal  Myotomy  by  Transverse  Incisions  299 

"  "  "    Longitudinal       "      300 

"  •'  "    Mixed  "     301 

"  "  "     Subcutaneous      "      802 

Accidents  following  Caudal  Myotomy 306 

Crural  Myotase.     Crural  Myotomy 30S 

Complications  of  Crural  Myotomy 311 

Operations  iipon  Fibrous  Tissues 312 


XU  CONTENTS. 

Operations  on  Muscles  and  their  Annexes— Continued.  page. 

Tenotomy 312 

Plantar  Tenotomy 312 

Accidents  Following 320' 

Carpal  Tenotomy 321 

Anti-Brachial  Tenotomy 32C 

Tarsal  Tenotomies 32.^ 

Cunean  Tenotomy 3~;j 

Peroneo-Phalangeal  Tenotomy 32G 

Tenotomy  in  Birds 327 

CHAPTER  VIII. 

Operations  on  the  Digestive  Apparatus. 

On  the  Teeth 32S 

Operative  Dental  Surgery SS'j 

Leveling  of  the  Teeth 335 

Extraction  of  Teeth 343 

Filing  Teeth 35a 

Canine  Dentistry 356 

Operations  on  tlie  Tongue 3'8 

Suture 36a 

Amputations.     Glossotomy 361 

Operations  on  Salivary  Glands 361 

Adenotomy 361 

Maxillary  Adenotomy 36C 

Operations  on  the  (Esophagus 364 

(Esophageal  Catheterism 366 

The  Taxis 370 

Crushing  the  Foreign  Body 372 

(Esophagotomy 373 

Accidents  Following 377 

Qastrotomy.    Rumenotomy 377 

Incision  of  the  Rumen 378 

Enterotomy 380 

Paracentesis 383 

Hernia 385 

Inguinal  Hernia 394 

Recent  Inguinal  Hernia 397 

Accidents  Following 411 


CONTENTS.  XIU 

Operations  on  Salivary  Glands— Continued.  page. 

Old  Inguinal  Hernia 411 

Inguinal  Hernia  in  Geldings 418 

Crural  Hernia 420 

Perineal      "      421 

Pancreatic  "      421 

Pelvic  or  Internal  Hernia  of  Oxen 421 

Umbilical  Hernia 425 

Diaphragmatic  Hernia 439 

Ventral  Hernia 443 

Eventrations 447 

Laparotomy 449 

CHAPTER  IX. 

Operations  on  the  Respiratory  Apparatus. 

On  the  Guttural  Pouches.    Hyovertebrotomy , 452 


Arytenectomy 462 

Fleming  Method 463 

Cadiot  Method 468 

Tracheotomy 477 

Accidents  Following 486 

Thoracentesis 488 

CHAPTER    X. 

Operations  on  the  Cirotilatory  System. 

Bleeding.     Venesection 492 

Phlebotomy 493 

Phlebotomy  in  Solipeds 496 

"  at  the  Jugular 497 

at  the  Cephalic 499 

"  on  the  Subcutaneous  Thoraciq 501 

"  at  the  Internal  Saphena oOl 

*'  on  other  Superficial  Veins 501 

'•  in  Large  Ruminant.s 503 

'*  on  the  Juaiular 504 

**  at  the  Subcutaneous  Abdominal  504 

"  on  Small  Animals 505 

Accidents  Following  Phlebotomy r 50(5 


XIV  CONTENTS. 

Operations  on  the  Circulatory  System.— Coutinued.  page. 

Arteriotomy 514 

Arteriotomy  at  the  Transversal  of  the  Face 514 

"  "    "    Posterior  Auricular 515 

"  "    "    Median  Caudal 516 

Capillary  Bleeding 517 

Bleeding  at  the  Palate 520 

"       "    ."    Coronet 531 

"    "    Foot 522 

Surgical  Hemostasia 523 

Temporarj'^  or  Preventive 524 

Permanent  or  Definite 528 

JPhysico-Chemical  Hemostatics 526 

Surgical  Hemostatics 530 

CHAPTER  XI. 
Opbrations  on  the  Nervous  Apparatus. 

Plantar  Neurotomy 541 

CHAPTER  XII. 
Operations  on  the  Genito-Urinary  Apparatus. 

Catheterism  of  the  Urethra 558 

Urethrotomy 558 

Preputial  Urethrotomy 561 

Scrotal  "  561 

Ischial  "  563 

Cystotomy 565 

Lithotrity 565 

Amputation  of  the  Penis 569 

CHAPTER  XIII. 
Operations  on  the  Foot. 

Anatomy 576 

Diseases  and  Defectuosities 583 

Vices  of  Conformation 583 

Instruments 5S9 

General  Operations 590 

Dressings  . .    591 


CONTENTS.  XV 

Operations  on  the  Foot— Continued.  page. 

Diseases.    Canker  of  the  foot 591 

Corns 607 

Sandcracks 616 

Calk , 637 

Punctured  Wounds  of  the  Foot 629 

Contracted  Heels.    Hoof  Bound 640 

Diseases  of  the  Frog 665 

Keraphyllocele 668 

Laminitis 669 

Navicular  Disease 694 

Quittor 703 

Cutaneous  Quittor 703 

Tendinous  Quittor 706 

Sub  Horny  Quittor  711 

Cartilaginous  Quittor 714 

CHAPTER  XIV. 
Opeeations  on  the  Eye  and  Eae. 
On  the  Eye. 

Operations  on  the  Accessory  Ocular  Organs 739 

Traumatic  Lesions  740 

Solutions  of  Continuity 740 

Defective  Congenital  Conformations 741 

Pathological  Growth  and  Caries  of  the  Membrana  Nictitans.  743 

Operations  on  the  Lachrymal  Apparatus 743 

On  the  Caruncula 743 

On  the  Lachrymal  Ducts 744 

On  the  Lachrymal  Canal 745 

Operations  on  the  Essential  Organs  of  Sight 746 

Extraction  of  Foreign  Bodies  on  the  Surface  of  the  Globe ...  748 

Paracentesis  of  the  Cornea 748 

Staphylonna 749 

Cataract 749 

Amputation  of  the  Eye 754 

Ocular  Prothesis 755 

On  the  Ear. 

Amputation 756 


XVI  CONTENTS. 

CHAPTER  XV. 

PAGE. 

Diseases  of  the  "Withees 759 

Excoriations 765 

Warm  (Edema 765 

Hematoma 766 

Core  or  Stickfast 766 

Abscess 769 

Wounds. .'. 770 

Diseased  or  Fistulous  Withers 771 

Terminations  of  Diseased  Withers 774 

Diseases  of  the  Poll 779 

Excoriations,  (Edematous  Swellings,  Core,  Bloody  Tumors. .  781 

Cyst 781 

Abscess 783 

Poll  Evil 784 


INTRODUCTION. 


Under  the  designation  of  operative  surgery  is  understood  that 
department  of  medical  science  and  practice  which  includes  the 
external  and  instrumental  manipulations  required  in  the  treat- 
ment of  surgical  diseases  and  accidental  injuries  or  deformities:. 
or  perhaps  it  might  be  succinctly  defined  as  surgical  science  vie- 
chanically  applied. 

The  two  branches — the  science  and  the  art — which  constitute 
the  study  of  operative  surgery  cannot,  of  course,  be  dissociated 
in  a  treatise  on  the  general  siibject,  and  it  will  therefore  be  neces- 
sary, as  we  proceed  with  the  detail  of  our  observations,  to  give 
due  consideration  to  the  setiology,  the  symptomatology,  the  pathol- 
ogy and  other  characteristic  features  of  certain  diseases,  in  their 
relations  to  the  indications  of  treatment  and  the  manipulations 
which  they  involve  at  the  hands  of  the  surgeon, 

Viewed  from  the  standpoint  of  comparative  importance  in  re- 
spect to  the  value  of  the  results  of  human  and  veterinary  surgery, 
as  relating  to  the  vital  status  of  the  patients  who  become  respect- 
ively the  subjects  of  both — the  human  being  and  the  quadruped 
races — veterinary  surgery  must  of  course  consent  to  occupy  the 
subordinate  place;  a  fact,  however,  by  no  means  tending  to  dis- 
parage the  value  or  the  just  estimation  of  the  calling  of  the  scien- 
tific veterinarian. 

In  human  surgery  the  one  paramount  result  held  up  to  view 
is  the  prolongation  of  the  life  of  the  patient.  This  is  a  consum- 
mation to  be  achieved  regardless  of  any  considerations  of  cost  or 
trouble,  while  in  veterinary  surgery  the  prime  motive  is  the  res- 
toration of  the  patient's  interrupted  ability  to  fulfil  his  function 
as  an  animated  machine  for  supplying  a  certain  amount  of  valu- 
able force.     For  these  reasons  the  scope  of  veterinary  practice  is 


*A  INTRODUCTION. 

a  circumscribed  one,  in  comparison  to  that  of  human  surgery,  by 
having  the  aim  and  being  brought  to  the  test  of  mere  economic 
utility.  While  the  human  Hfe  is  prolonged  at  any  cost,  moreover, 
the  treatment  of  the  animal  is  always  suj)plemented  and  influ- 
enced by  the  consideration  that  if  curative  eiforts  fail,  the  suffer- 
ings of  the  patient  may  be  terminated  by  the  administration  of 
a  prescription  which  will  at  once  release  him  from  pain  and  de- 
prive him  of  life,  with  the  full  sanction  both  of  self-interest  and 
benevolent  feehngi 

Another  element  which  operates  to  define  the  sphere  of  the 
veterinary  surgeon  is  the  natural  disinclination  of  the  owner  of 
a  sick  or  disabled  animal — perhaps  a  man  of  limited  pecuniary 
resources — in  a  tedious  and  unpromising  case,  to  add  to  the  ex- 
pense of  surgical  attendance  the  cost  of  the  unremunerated 
"keep"  of  his  disabled  and  improductive  servant. 

It  ought  to  be  true,  as  a  matter  of  course  (perhaps  it  is  so  in 
point  of  fact),  that  no  man  of  intelligence  and  integrity  will  as- 
sume the  duties  and  i*esponsibilities  of  surgical  practice  without 
the  due  preparation  and  equipment,  which  is  only  to  be  acquired 
by  conscientious  study  and  comjDetent  knowledge  of  medical 
science  at  large.  Especially  and  indisj^ensably  a  surgeon  must 
be  an  accomplished  anatomist.  His  knowledge  must  be  thorough 
and  practical  in  the  several  di\dsions  of  anatomical  science — he 
must  possess  a  familiar  acquaintance  with  clescrij^tive  anatomy ; 
he  must  be  fully  instructed  in  surgical  anatojuy  or  the  anatomy 
of  regions  ;  he  must  have  mastered  the  last  chapter  in  pathologi- 
cal anatomy ;  and  if  there  are  any  other  kinds  of  anatomy,  he 
must  master  them  all,  and  then  he  will  have  become  an  anatomist 
in  fact,  and  qualified  to  practice  surgery.  Yes;  a  surgeon  must 
be  an  Anatomist. 

And  it  ought  to  go  without  saying,  that  only  a  surgeon  should 
practice  surgery,  whether  his  patient  be  biped  or  quadruxDed.  No 
untrained  layman  should  presume  to  wield  the  knife  and  the 
cautery  with  their  associated  arsenal  of  weapons  and  other  appli- 
ances for  the  subjugation  of  the  enemy  whose  assaults  it  is  the 
special  province  of  the  surgeon  to  repel.  An  ignorant  operator 
may  easily  become,  himself,  a  more  dangerous  "  lesion  "  than  some 
of  those  which  he  presumes  to  treat.  The  man  who  can  cut  into 
the  living,  and  usually  hypersensitive,  flesh  of  a  suffering  animal, 
without  knowing  what  tissue  or  organ  he  is  attacking,  what  artery 


INTEODUCTION.  3 

he  is  likely  to  sever,  what  nerve  to  wound,  what  organ  to  lacerate, 
what  function  to  paralyze ;  who  would  essay  the  operation  of  neu- 
rotomy without  knowing  where  to  look  for  the  plantar  nerve ;  who 
would  undertake  a  case  of  vaginal  spaying  in  ignorance  of  the 
location  of  the  flying  ovaries;  or  who  would  operate  for  strangu- 
lated hernia  unaware  of  the  mode  of  avoiding  the  infliction  of 
injury  upon  the  posterior  abdominal  artery — such  a  man,  if  to  be 
found,  should  simply  be  subjected  to  an  odium  which  should 
ostracise  him  from  honorable  and  equal  association  with  others 
of  his  species,  besides  being  held  criminally  amenable  to  the  law 
providing  penalties  for  the  perpetrators  of  cruelty  to  animals 

These  reflections  may  be  unnecessary,  but  it  is  all  too  true 
that  om-  domestic  animals  too  often  become  the  victims  of  worse 
than  brutal  masters,  who  take  advantage  of  their  helplessness  and 
inferiority  to  inflict  upon  them  cruelties  so  gross  and  aggravated 
that  right-feehng  men  are  often  compelled  to  blush  to  call  them 
feUows.  It  is  no  excuse  for  this  that  it  is  done  through  the 
agency  of  a  pseudo-surgeon  :  such  a  plea  merely  doubles  the 
number  of  the  wrong-doers. 

In  offering  these  suggestions,  and  in  formulating  the  informa- 
tion which  follows,  derived  from  the  experiences  of  many  studious 
and  observant  men,  and  which  in  their  aggregate  and  connected 
form  constitute  the  substance  of  this  volume,  it  is  assumed  that 
it  is  only  from  competent  and  qualified  minds  that  the  apprecia- 
tion which  it  hopes  to  merit  and  to  receive  must  come,  and  we 
trust  that  to  the  extent  of  its  justice  and  truth  it  will  not  be 
withheld. 

With  the  skill  of  the  expert  anatomist  must  be  associated,  of 
course,  the  necessary  mastery  of  tlier<ipex(,tics  and  a  familiar  knowl- 
edge of  special  and  general  pathology,  and  all  should  be  supple- 
mented by  a  knowledge  of  the  theory  and  practice  of  the  farrier. 

The  science  and  the  application  of  the  laws  of  hygiene,  so 
generally,  indeed  almost  wholly,  ignored  by  our  fathers,  and  so 
largely  a  discovery  of  the  present  time,  will  never  be  overlooked  or 
depreciated  by  the  genuine  surgeon ;  and  while  possibly  the  effects 
of  meteorological  influences  may  have  become  of  less  importance 
than  they  were  considered  to  be  in  times  gone  by,  a  careful  ob- 
servance of  their  phenomena  will  never  be  a  useless  item  of  acqui- 
sition. The  fullest  attention  to  the  theories  and  appUcation  of 
what  may  be  denominated  the  science  of  antisepsis,  and  the  adap- 


INTKODUCTION. 


tation  of  antiseptic  measures,  now  so  universally  and  unintermit- 
ting  an  adjunct  to  all  medical  and  surgical  practice,  and  so  utterly 
indisj)ensable  in  the  departments  of  dressing  and  nursing,  and  so 
often  an  available  and  valuable  aid  in  the  very  act  of  operating, 
must  be  considered  now  to  have  become  an  incorporated  and  con- 
stituent department  of  the  domain  of  surgery,  and  medicine  as 
well,  and  the  cultured  veterinarian  will  of  course  so  regard  it  in 
his  practice. 

Without  being  necessarily  a  practical  worker  at  the  anvil,  the 
surgeon,  as  we  have  intimated,  must  acquire  a  familiar  acquaint- 
ance with  the  theories  and  the  art  of  the  farrier.  No  one  can 
place  too  high  an  estimate  upon  the  importance  of  the  position 
occupied  by  the  foot  among  the  anatomical  regions  where  lesions 
may  be  expected  to  occur,  and  whereas  the  shoe  becomes  practi- 
cally identified  with  the  Hving  member,  and  is,  in  use,  a  portion  of 
the  hoof  itself,  by  the  act  of  nailing  the  shoe  and  the  hoof  together 
the  inference  becomes  palpable.  An  occasion  may  easily  arise 
when  a  serious  blunder  in  treatment  may  be  traced  to  a  previous 
bkmder  in  diagnosis,  which  agaia  may  be  referred  to  an  earlier 
blunder  still,  which  has  consisted  ia  neglecting  to  examine  the 
foot,  and  the  shoe  which  has  injured  it.  What  is  the  status,  in 
respect  to  his  market  value,  of  a  horse  with  poor  feet,  or  whose 
good  feet  have  been  ruined  by  bad  shoeing  ?  So  the  veterinary 
sui'geon,  though  not  required  to  be  able  to  make  a  set  of  shoes, 
should  be  ex^^ected  to  know  how  they  ought  to  be  made  and  fast- 
ened. And  when  a  special  shoe  is  required  for  the  correction  of 
a  deformity,  or  as  indicated  in  some  diseased  condition  of  the  foot, 
it  will  of  coiu'se  become  the  exclusive  province  of  the  surgeon  to 
dictate  the  whole  process  of  forging  and  fastening,  and  to  see  that 
his  instructions  are  not  ignored. 

Besides  the  special  scientific  attainments  to  which  we  have 
referred,  there  are  many  other  qualifications  which  must  enter 
into  the  character  of  the  good  and  skillful  surgeon,  in  order  to 
round  it  into  true  symmetry  and  proportion.  Bouley  remarks 
that  "he  must  not  oidy  be  a  man  of  science,  but  a  man  of  art," 
meaning,  we  suppose,  that  he  should  not  only  possess  knowledge, 
but  know  how  to  make  it  available.  First,  he  must  possess  the 
faculty  of  knowing  how  to  gauge  the  necessity  of  his  interference, 
with  its  manner  and  its  duration ;  or,  on  the  other  hand,  whether 
any  interference  is  necessary,  and  whether  the  true  indication  is 


INTRODUCTIO^r.  O 

not  to  refrain  entirely  from  active  measures.  The  result  of  his 
decision  will  afford  a  good  test  and  gauge  of  the  extent  to  which 
he  has  profited  by  his  clinical  and  theoretical  study.  He  is  a 
sound  philosopher  who  can  wisely  determine  when  to  let  alone,  in 
opposition  to  the  temptation  to  do  something. 

The  acquisition  of  manual  dexterity  is  an  accomplishment  of 
prime  importance  and  should  be  acquu'ed,  and  can  only  be  earned 
by  diligent  practice  upon  the  cadaver,  or,  what  perhaps  is  more 
effectual,  besides  being  in  itself  real  work,  by  utilizing  every  op- 
portunity of  performing  minor  operations,  under  suitable  instruc- 
tion, upon  actual  patients.  Of  course,  expertness  without  practice 
is  impossible.  It  is  not  fully  correct,  perhaps,  to  speak  of  manual 
dexterity  in  the  singular  number.  The  dexterity  required  should 
be  bi-manvial  or  ambi-dexterity,  and  any  surgeon  who  has  not 
mastered  the  art  of  using  both  hands  indifferently,  though  he  may 
have  learned  all  else  pertaining  to  his  profession,  lacks  yet  one 
thing.  Cases  will  continually  arise  in  which  the  inabihty  to  change 
hands  may  interrupt  the  progress  of  an  ojDeration  and  involve  the 
practitioner  in  great  inconvenience,  if  not  embarrassment,  and 
possibly  prejudice  the  case  itself. 

Courage  and  coolness,  with  patience,  are  essential  qualities  of 
temper  in  an  operating  surgeon.  To  become  alarmed  and  lose  his 
balance  on  the  occurrence  of  some  untoward  incident,  or  the  ap- 
pearance of  some  unlooked-for  abnormal  development  or  compli- 
cation, or  to  give  way  to  a  spuit  of  impatience  because  of  unex- 
pected delays,  or,  especially,  to  resent  the  fractious  movements  of 
the  suffering  animal,  writhing  under  the  knife  or  the  glowing 
cautery,  is  both  unprofessional  and  unmanly.  The  terms  coui-- 
age,  coolness,  patience  and  kindness  should  describe  his  state  of 
mind  while  operating. 

The  whole  axiom  of  Asclepiades,  cito,  tuto  and  J ucimde,  re- 
veals the  entire  scheme  of  conduct  proper  for  the  surgeon  under 
all  circumstances.  Every  movement  of  the  surgeon  should  be 
prompt  and  precise.  Indeed,  by  operating  rapidly  he  shortens 
the  duration,  and  consequently  the  sum  of  the  inevitable  pain, 
and  thus  diminishes  the  anguish  of  a  long  and  torturing  infliction 
on  behalf  of  the  patient.  The  maintenance  of  his  own  self-possession 
will  make  him  master  of  the  situation,  and  assure  a  neat  and  ar- 
tistic finish  to  his  task,  with  no  imnecessary  divisions  of  tissues, 
no  mistaking  of  localities,  and  generally  with  no  betrayals  of 


6  INTRODUCTION. 

doubt  and  hesitation  or  awkward  and  aimless  manipulations,  such 
as  mark  the  attempts  of  the  tyro  and  the  novice.  The  confidence 
and  facility  with  which  each  movement  is  accomplished  will  not 
fail  to  impress  favorably  those  who  are  sjDectators  of  the  opera- 
tion, and  to  react  favorably  and  profitably  for  the  oj)erators. 

Although,  of  course,  the  qualities  of  accuracy,  neatness  and 
rapidity  must  favorably  impress  the  spectator,  as  well  as  benefit 
the  patient,  it  must  not  be  forgotten  that  the  true  success  of  the 
surgeon  must  find  its  evidence  in  the  favorable  result  which 
finally  crowns  his  work.  If  that  is  assured,  it  is  but  a  small 
matter  whether  it  is  or  is  not  applauded  while  in  progress — the 
applause  will  follow,  in  any  case. 

We  quote  from  Bouley,  in  the  Dictionnaire  de  Medecine  et  de 
Chirurgie  VHerinaire,  where  he  remarks,  on  another  important 
practical  point:  "The  operative  function  of  veterinary  surgery 
requires,  on  the  part  of  the  man  who  practices  it,  a  certain  cor- 
poreal vigor,  associated  with  sufficient  agility  to  be  able  effectually 
to  overcome  the  resistance  of  animals  under  torture,  and  coimter- 
act  the  efforts  and  avoid  the  injuries  they  are  always  so  prompt 
and  often  so  dexterous  to  inflict  upon  those  who  are  causing  them 
pain.  ■  The  veterinary  surgeon  must  be  cool-blooded  and  patient, 
never  losing  his  presence  of  mind  while  directing  the  manijDula- 
tions,  often  so  difficult  and  so  dangerous,  which  are  necessitated 
at  his  hands,  especially  when  the  large  domestic  animals  are  under 
treatment.  He  must  then — always,  in  fact — be  prepared  for  all 
difficulties  and  eventualities  that  may  arise,  whether  before,  diu'ing 
or  after  an  operation,  and  he  must  inspu-e  confidence  in  his  assist- 
ants by  using  full  precautions  for  their  safety  and  for  his  own,  in 
his  defensive  dispositions  against  the  dangers  to  which  they  are 
exposed." 

A  surgical  oj)eration,  as  elsewhere  described,  is  a  mechanical 
action,  practiced  with  more  or  less  rapidity  upon  the  living  body, 
according  to  certain  rules,  either  with  the  hand  alone,  or  assisted 
by  instruments,  with  a  therapeutical  or  a  prophylactic  object  in 
view,  whether  primarily  necessary  or  facultative,  of  a  prophylactic 
nature. 

It  is  especially  as  therapeutic  measures  that  operations  are 
necessitated  in  the  treatment  of  diseases  and  injuries;  as,  for  ex- 
ample, in  the  case  of  the  removal  or  extirpation  of  diseased  or 
altered  parts,  whose  morbid  action  injuriously  affects  the  general 


INTRODUCTION.  Y 

health  or  prevents  recovery  from  a  pre-existing  disease.  This 
class  of  operations  includes  the  opening  of  abscesses,  the  extii'pa- 
tion  of  gangrenous  parts,  or  of  necrosed  or  carious  bone ;  or  again, 
for  the  modification  of  the  nature  of  a  traumatic  lesion,  in  order  to 
stimulate  cicatrization,  as  in  the  opening  of  a  fistulous  tract,  or 
the  resection  of  an  ulcerated  surface;  or  when  the  economy  is  to 
be  relieved  from  the  presence  of  a  foreign  body,  or  the  abnormal 
product  of  a  natural  function,  as  in  cases  of  oesophagotomy,  or 
of  calcuh  of  the  bladder,  or  of  the  saUvary  ducts.  Operations  have 
also  their  prophylactic  uses,  especially  in  the  various  forms  of  in- 
oculation and  vaccination  as  anticipatory  and  preventive  of  infec- 
tious diseases.  They  find  their  further  obvious  indications,  again, 
in  remedying  physical  lesions  when  applied  to  fractures,  dislo- 
cations, deformities,  and  the  endless  Hst  of  accidental  injuries, 
wounds  and  hurts  of  every  kind  and  degree.  And,  finally,  they 
have  their  justifiable  use  in  mutilating  the  larger  domestic  animals, 
designed  for  purposes  of  labor  as  beasts  of  burden  or  draught,  in 
improving  their  adaptability  by  castration  or  spaying,  or  as  prop- 
erly termed,  "altering." 

Thus  the  general  purpose  of  an  operation  is  to  paUiate,  cure 
or  assist  in  the  recovery  of  surgical  diseases ;  to  prevent  diseases, 
and  especially  such  as  are  known  to  be  contagious;  and  so  to 
modify  the  condition  of  the  domesticated  animals  as  to  enhance 
their  usefulness  and  value  to  their  human  owners. 

In  medical  nomenclature,  operations  are  variously  designated 
according  to  the  methods  and  characteristic  manipulations  attend- 
ing their  performance,  and  the  objects  which  they  are  designed 
to  accomplish.     Thus: 

(a)  It  is  a  light  operation  when  superficial  tissues  or  those  of 
secondary  importance  are  involved,  like  that  of  venesection,  or  the 
simple  pimcture  of  a  vein.  On  the  other  hand,  it  becomes  serious 
when  it  is  performed  upon  important  organs,  or  involves  extensive 
and  compHcated  structures,  as  that  for  the  reduction  of  strangu- 
lated hernia;  the  removal  of  the  lateral  cartilage  of  the  foot  in  a 
case  of  quittor;  the  operation  for  chronic  champignon,  etc.,  etc. 

(b)  Operations  are  also  dri/  or  bloodless  when  accompanied  by 
little  or  no  hemorrhage ;  and  sanguinary  or  bloody  when,  on  the 
contrary,  much  hemorrhage  attends  any  of  their  various  steps. 

(c)  Again,  they  are  simjile  or  complicated  according  to  the 
extent  and  multiplicity  of  the  tissues  or  regions  forming  their 


8  INTRODUCTION. 

seat ;  simjyle  if  performed  by  a  single  manij)ulation,  complicated 
when  requiring  several  distinct  or  separate  stages  for  their  exe- 
cution. 

{d)  Operations  are  called  regidar  or  determhiate  when  per- 
formed according  to  rules  in  relation  to  the  disjDOsition  of  the 
parts,  and,  in  general,  upon  sound  structui-es;  and  they  become 
irregidar  or  casual  when  the  manipulations  are  extemporized  to 
meet  the  emergencies  of  the  case,  the  necessity  of  the  situation 
and  the  unanticipated  compHcations  which  may  arise  while  opera- 
ting, as  particularly  in  cases  of  the  removal  of  tumors. 

(e)  They  have  also  received  various  designations  indicative  of 
the  time  chosen  by  the  surgeon  for  their  performance;  or  made 
imperative  by  the  circumstances  of  the  case  ;  or  according  to  the 
object  specifically  in  view :  thus  they  are  to- gent  or  of  necessity 
when  a  fatal  event  would  be  the  alternative  of  delay,  and  imme- 
diate treatment  becomes  imperative,  as  the  condition  of  the 
patient's  survival,  as  in  operation  for  the  reduction  of  strangu- 
lated hernia,  or  that  of  tracheotomy  in  a  case  of  threatening  suf- 
focation; and  in  cases  beyond  hope  of  complete  recovery,  they  may 
become  necessary,  ind'ispetisahle,  useful  or  palliative,  according 
to  the  degree  in  which  they  may  be  made  available  as  a  means  of 
relief,  and  may  tend  to  the  temporary  respite  of  the  sufferer,  and 
in  some  degree  improve  his  value  by  measurably  enhancing  his 
abihty  to  continue  to  labor  with  some  degree  of  comfort  before 
he  is  overtaken  by  a  final  and  total  disabihty. 

There  is  another  class  of  operations  which  justly  deserves  to 
be  totally  discountenanced  and  ignored,  and  in  fact  are  fit  objects 
for  penal  prohibition.  They  are  known  as  operations  of  fantasy 
or  fashion.  They  are  without  real  utihty;  are  abortive  attempts 
to  improve  upon  the  symmetry  of  nature ;  are  devised  simj)ly  to 
satisfy  a  mere  whim  of  affectation ;  are  in  wretchedly  poor  taste ; 
and  probably  subject  theu'  victims  to  a  more  aggravated  and  pro- 
tracted species  of  torture  than  any  other  form  of  wound  known  to 
veterinary  surgery.  There  are  sometimes  conditions,  however,  in 
which  they  may  lose  theu-  alleged  aesthetic  pretext  and  their  ar- 
tistic character,  and  the  object  of  their  performance  may  be 
regarded  as  properly  within  the  legitimate  and  beneficial  sphere 
of  professional  work. 

The  settlement  of  the  point  of  the  time,  in  connection  with 
any  piece  of  surgical  work,  is  not  always  one  of  mere  secondary 


INTRODUCTION. 


importance  in  deciding  the  matters  pertaining  to  the  details  of 
an  operation.  When  there  is  any  ojytlon  in  the  case  it  pertains 
wholly  to  the  surgeon  to  determine  the  question.  And  when  the 
period  of  abeyance  has  terminated  by  his  decision  in  fixing  the 
day  and  horn-  when  the  contemj^lated  treatment  is  to  be  applied, 
the  optional  time  becomes  changed  to  the  selected  time.  Of -course 
it  is  not  always  left  to  the  option  of  the  practitioner  to  select  the 
moment  for  the  accompUshment  of  his  task.  He  must  be  gov- 
erned by  the  nature  of  the  case,  and  may  be  left  without  the 
opportunity  of  exercising  any  discretion  in  the  matter.  The 
urgency  of  the  occasion  may  be  extreme,  with  no  interval  allow- 
able for  deliberation  or  choice,  and  the  only  available  time,  the 
peremptory  present,  must  be  accepted  as  that  of  necessity. 

The  operation  being  now  obhgatory,  and  the  case  understood, 
the  surgeon's  next  thought  is  the  choice  of  the  locality  of  the 
operation,  and  that  being  finally  decided,  the  point  of  selection 
has  been  reached.  The  case  may  easily  present  such  features  that 
this  point  becomes  too  obvious  for  hesitation  by  becoming  that  of 
selection  as  well  as  that  of  necessity,  as  indicated  by  the  seat  of 
the  lesion  or  diseased  process.  With  traumatic  cases,  there  is, 
of  course,  but  a  single  point  of  interest — it  is  i\xG  point  of  injury  ! 

In  surgical  phraseology  the  terms  method  and  procedure  are 
often  used  convertibly.  There  is  between  them,  however,  a  dis- 
tinction which,  for  the  sake  of  precision,  must  not  be  lost  sight  of. 
By  method  should  be  understood  the  princij)al  and  primordial 
mode  by  which  the  operation  is  performed,  while  \>^  procedure  is 
meant  the  special  modifications  and  successive  stages  by  which 
the  manipulations  of  the  operation  itself  are  regulated.  For  ex- 
ample, in  the  removal  of  a  vesical  calculus  there  is  one  method  by 
hthotrity  and  another  by  extraction,  and  with  both  are  involved 
the  insertion  of  instruments  into  the  urethral  canal,  one  being  the 
jiTocedure  with  the  catheter,  and  the  other  the  procedure  by  the 
injection  of  tepid  water.  Castration  with  clamps  is  a  method, 
when  compared  to  double  subcutaneous  twisting  {Mstournage)  or 
to  torsion;  and  it  is  performed  by  two  procedures,  that  by  covered 
and  that  by  uncovered  testicles. 

There  are  several  important  points  which  demand  special  at- 
tention at  the  hands  of  the  surgeon  before  beginning  an  operation. 
Having  finally  reviewed  the  situation,  and  especially  having  men- 
tally rehearsed  the  anatomical  disposition  of  the  region  and  the 


10  INTEODUCTION. 

pathological  character  of  the  lesion,  with  the  necessary  details  of 
the  work  before  him,  not  forgetting  to  anticipate  possible  acci- 
dents and  coni]DHcations ;  and  being  assured  that  his  arsenal  of 
instruments,  dressings,  etc.,  is  ample  and  in  good  and  available 
order,  with  a  liberal  provision  of  sponges,  antiseptics,  etc.,  and 
duplicates  of  such  of  the  instruments  as  are  liable  to  be  broken 
or  otherwise  disabled,  the  condition  of  the  patient  should  then  be 
ascertained.  It  will,  of  course,  have  been  thoroughly  understood 
by  the  surgeon  previously,  but  it  is  always  among  possibilities 
that  even  at  the  appointed  moment  for  operating,  some  changes 
may  be  discovered  or  some  new  circumstances  developed  which 
may  modify  or  contraindicate  the  entire  proceeding. 

Some  final  preparation  of  the  patient  is  always  necessary.  One 
item  of  this  consists  in  clipping  the  hair  from  the  skin  over  the 
seat  of  the  operation,  and  thoroughly  cleansing  the  part.  In 
some  cases  it  is  necessary  to  soften  the  tissues  by  means  of  poul- 
tices, baths  or  wet  bandages.  There  is  also  a  constitutional  and 
general  preparation  which  must  not  be  neglected,  with  a  \T.ew  to 
so  modify  the  organism  as  to  improve  the  ability  of  the  animal  to 
withstand  the  shock  of  the  operation.  If  weak  and  debilitated, 
his  strength  and  condition  must  be  improved;  if  of  an  irritable 
and  nervous  disposition,  precautions  must  be  taken  to  control  it. 
A  comparatively  low  diet  is  almost  always  a  salutary  measiu*e, 
and  sometimes  even  complete  diet  an  essential  preliminary  to  an 
operation,  and  the  surgeon  must  assure  himself  that  they  have 
been  properly  taken  into  consideration. 

In  many  cases  the  surgeon  needs  the  co-operation  of  assistants, 
either  professional  men  or  laymen.  The  aid  rendered  by  a  profes- 
sional brother  or  by  a  student  of  mediciue  will  of  course  be  such 
as  will  be  assigned  to  him  by  the  responsible  surgeon,  and  cannot 
be  specified  here — it  wiU  vary  with  every  case.  The  facility  and 
success  of  an  operation  wiU  be  greatly  promoted  by  their  intelli- 
gent and  sympathetic  aid,  which  will  be  quite  of  an  indispensable 
character.  In  enlisting  laymen  as  assistants,  it  will  of  coiu'se 
devolve  on  the  surgeon  to  instruct  them  as  fully  as  jDOSsible  in 
the  nature  of  the  services  expected  from  them ;  and  in  making  his 
selection  of  indi^dduals  it  will  be  an  important  point  gained  if  he 
can  obtain  those  who  are  accustomed  to  the  management  of  ani- 
mals, and  who  are  expert  in  handling  and  successful  in  controlling 
them. 


INTRODUCTION.  11 

There  is  still  another  party  to  be  considered  while  referring  to 
the  study  of  "  j)reparation."  It  is  neither  the  animal,  the  surgeon, 
the  assistants,  the  instrument  case,  nor  the  lint  and  bandages.  It 
is  the  owner  of  the  ailing  animal.  And  to  "  prepare  "  him  for  the 
event  is  oftentimes  a  performance  requiring  a  larger  amount  of 
judgment,  tact,  knowledge  of  human  nature  and  patience  than 
the  average  man  possesses.  On  the  one  hand  there  are  those  of 
the  optimist  class  who  have  quite  an  unwarranted  opinion  of  the 
power  of  surgery,  and  who,  in  despite  of  the  most  unfavorable 
prognosis,  insist  upon  a  resort  to  the  knife,  even  upon  inadequate 
occasions.  And  on  the  other  hand  are  those  who  interpret  any 
suggestion  which  involves  a  solution  of  continuity  professionally 
proposed,  however  artistically  consummated,  as  only  a  mild  form 
of  sentence  of  death  to  the  patient.  But  however  antipodean 
may  be  their  views  in  other  respects,  they  are  in  common  quite 
assured  that  for  an  operation  which  fails  to  restore  the  dilapidated 
patient  to  a  condition  a  little  better  than  new,  whatsoever  may 
have  been  the  accident  or  lesion  which  he  may  have  encountered, 
and  whatsoever  may  have  been  the  skill  and  inteUigence  exhibited 
in  the  treatment  of  his  wounds  or  ailments,  the  only  legitimate 
and  orderly  conclusion  is  a  suit  at  law  for  malpractice.  It  is  the 
function  of  the  doctor  to  cure  disease ;  if  he  treats  disease  without 
curing  it,  he  is  an  incompetent;  this  is  the  irrefragable  logic! 
Though  the  living  animal  had  failed  to  return  any  remuneration 
for  his  subsistence,  and  for  the  care  lavished  (?)  on  him  diu'ing 
the  period  of  his  disability,  yet  when  reduced  to  the  state  of  a 
cadaver  he  should  be  compelled,  if  possible,  in  an  indirect  way  to 
net  his  bereaved  owner  a  sum  Kkely  to  prove  largely  anodyne  to 
the  poignancy  of  the  grief  which  the  loss  of  so  much  property 
had  excited. 

But  aside  from  this,  the  owner  of  the  living  property,  the  value 
of  which  is  about  to  be  jeopardized,  is  entitled  to  a  full  and  candid 
statement  of  the  nature  of  the  case,  with  its  possibilities  and  its 
dangers,  and  it  is  in  the  interest  of  the  surgeon  himself  to  observe 
perfect  frankness  with  his  employer — not,  however,  to  the  extent 
of  compromising  his  position  as  doctus  in  the  case,  or  foregoing 
his  self-respect  by  making  concessions  upon  points  of  scientific 
acquisition  to  a  layman,  however  generally  intelligent  or  specially 
interested.  The  surgeon  must  assert  himself  as  the  representa- 
tive and  exponent  of  an  honorable  and  learned  profession,  able 


12 


INTKODUCTION. 


and  prepared  to  acquit  himself  of  his  just  responsibilities;  and, 
indeed,  it  is  in  this  assumption  by  him,  with  the  conceded  assent 
of  the  owner,  that  the  vii'tue  of  the  contract  lies,  which  binds  the 
two  parties  with  equal  force,  moral  and  legal. 

This  point,  being  understood  and  settled,  should  be  looked 
upon  as  furnishing  the  best  preparation  which  the  owner  can  ac- 
quire, and  he  will  need  no  other  when  he  is  thus  made  to  under- 
stand that  he  must  have  full  confidence  in  the  skill  which  he  has 
called  into  requisition,  and  must  be  guided  by  its  impUed  guar- 
antee that  every  possible  precaution  will  be  taken  to  carry  the 
patient  through  his  trouble ;  and  that  if  accidents  of  any  nature 
should  occur,  when  not  incurred  thi'ough  carelessness  or  error, 
the  risk  is  the  owner's,  and  he  alone  must  assume  it.  Such  an 
understanding  on  the  part  of  the  owner  will  impose  upon  the 
honorable  sm-geon  an  imperative  sense  of  the  conscientious  care 
with  which  his  task  should  be  performed,  while  at  the  same  time 
it  will  relieve  his  mind  from  the  pressure  of  a  possibly  embarrass- 
ing anxiety  while  engaged  in  his  work,  and  it  cannot  fail  to  be  of 
advantage  in  various  ways  to  all  the  parties  concerned. 

Minor  matters,  such  as  the  condition  of  the  weather,  the 
time  of  day,  the  selection  of  a  place,  the  position  which  the  oper- 
ator must  assume  for  himself,  with  that  which  he  assigns  to  the 
patient — these  are  points  which  are  also  to  be  carefully  taken  into 
consideration.  They  have,  one  and  all,  more  or  less  influence  on 
the  facilities  of  execution  of  an  operation,  and  perhaps  also  on  the 
results  that  may  follow  it. 


CHAPTEE  I. 
MEANS    OF   RESTRAINT. 

The  final  preliminary  before  operating  upon  animals,  is  to  place 
the  patient  in  such  a  condition  of  restraint  as  will  assure  the  entire 
safety  of  the  surgeon  and  his  assistants  from  injury  likely  to  result 
from  the  violent  struggles  of  the  terrified  and  suffering  creature. 
The  severity  or  the  duration  of  the  operation  fiirnishes  no  accurate 
measure  of  the  necessity  of  the  restraint,  or  of  its  continuance  or 
degree.  Any  unusual  or  violent  aggressive  treatment  will  excite 
his  fears,  and  consequently  his  opposition,  and  whether  the  occa- 
sion be  a  painfiil  and  protracted  dissection,  or  the  simple  applica- 
tion of  a  dressing,  the  surgeon  may  usually  rely  on  the  strenuous 
resistance  of  the  patient.  It  is  of  Httle  account  that  there  are 
differences  of  dispositions  in  horses,  as  in  men.  "With  any  un- 
reasoning animal  the  case  is  the  same,  and  with  the  excitement, 
the  anxiety,  and  no  doubt,  a  vague  terror  of  something  unknown 
impending,  too  often  quite  explainable  by  the  treatment  to  which 
he  has  been  long  accustomed  at  the  hands  of  an  unfeeling  owner, 
he  is  prompted  by  the  mere  instinct  of  self-preservation  to  defend 
himself  with  such  means  as  nature  has  taught  him  to  use.  The 
necessity  of  enforcing  a  passive  condition  in  the  animal  being  thus 
ajjparent,  it  ought  not  to  be  necessary  to  say  that  the  means  of 
accompHshing  it  should  be  employed  with  reserve  and  moderation, 
especially  when  they  are  painful  in  themselves,  and  that  no  man 
claiming  to  be  the  possessor  of  humane  instincts  will  permit 
himself  to  increase  the  severity  of  theu'  application  by  supplement- 
ary ill  treatment,  in  the  infliction  of  "punishment,"  upon  the 
alarmed  and  suffering  brute,  a  course  which  is  quite  likely,  more- 
over, to  be  as  HI  judged  as  it  is  otherwise  reprehensible,  from  the 
fact  that  in  most  instances  its  effect  is  contraiy  to  its  intention,  in 
aggravating  the  evil  it  would  remedy.  It  should  never  be  forgotten 
how  easily  the  most  fractious  and  timid  animal  may  sometimes  be 
controlled  by  kindness  and  patience,  and  his  agitation  soothed  by 


14  MEANS    OF    RESTRAINT. 

the  sound  of  a  familiar  voice  witli  whicli  he  has  become  accustomed 
to  associate  acts  of  gentleness  and  friendliness.  Under  any  cir- 
cumstances, a  habit  on  the  part  of  the  surgeon,  of  brutal  treatment, 
the  exhibition  of  a  bad  temper,  in  the  indulgence  of  fits  of  anger, 
leading  to  acts  of  cruelty  in  the  infliction  of  unnecessary  pain  on 
his  dumb  and  helpless  victim,  is  not  only  in  every  way  useless,  as 
being  of  no  possible  advantage  in  any  direction,  but  tends  to  a 
degree  of  moral  harra  in  those  who  are  thus  cvilpable  for  which  no 
cormterbalancing  benefit  can  be  imagined,  and  which  certainly  can 
never  facilitate  the  remedial  effect — but  quite  the  reverse — of  the 
pending  operation. 

A  benignant  method  of  controlling  animals  for  the  special 
purpose  for  which  treatment  by  the  surgeon  is  invoked,  is  not, 
however,  alone  sufficient,  and  it  is  thus  that  a  resort  to  efi"ective 
means  of  physical  restraint  becomes  unavoidable. 

These  are  of  two  kinds :  one  consists  in  inflicting  upon  some 
given  part  of  the  body,  more  or  less  remote  from  the  seat  of  the 
operation,  a  severe  and  continuous  pain,  which,  by  a  process  of 
derivation,  reduces  that  which  is  incident  to  the  steps  of  the 
operation,  by  distracting  or  diverting  the  consciousness  from  the 
influence  of  the  new  suffering,  against  which  he  feels  resistance 
would  be  in  vain,  to  that  of  which  he  is  sensibly  cognizant,  and 
thus  the  animal  submits  himself,  with  a  comparatively  voluntary 
sm-render. 

The  other  kind  consists  of  restraints  proper,  and  are  constituted 
of  mechanical  dcAices  for  securing  immobihty  by  the  process  of 
overcoming  opposition  by  means  of  a  dominating  physical  force. 
Their  use  is  not  affected  by  the  position  of  the  subject,  and  they 
are  therefore  applied  in  both  the  upright  and  decubital  posture. 
The  first  comprehends  the  derivative  or  j^ainful  method  of  Peuch 
and  Toussaint's  division ;  the  second,  the  method  by  direct  7ne- 
chanical  restraint. 

MEANS   OF   SECURING  SOLIPEDS. 

A. — Derivative  or  Painful  Method. 

This  method  is  in  very  common  use,  and  usually  proves  to  be 
sufficiently  efiective  to  secui'e  a  degree  of  quiet  and  passivity  in 
the  patient  for  the  safe  performance  of  many  Ught  ojDerations. 
Under  some  circumstances  it  is  used  in  connection  with  the  means 


SECUKING    SOLIPEDS.  15 

of  direct  restraint.  The  instruments  mostly  employed  in  the  first 
method  consist  of  the  twitch,  the  old  fashioned  barnacle,  and 
the  gag. 


Pig.  1.— The  Twitch. 

The  twitch  is  the  instrument  most  commonly  used  and,  un- 
fortunately, too  commonly  abused.  In  horses,  it  is  sometimes 
apphed  on  one  of  the  ears,  and  sometimes  on  one  of  the  hps ;  and 
is  very  severe  in  its  action,  wherever  applied. 

In  applying  it,  the  operator,  passing  his  right  hand  through 
the  loop  of  cord  of  the  instrument,  grasps  the  tip  of  the  upper  or 
the  mass  of  the  lower  lip,  leaving  the  loop  to  slip  over  his  fingers 
close  to  the  skin  which  it  then  encloses,  and  with  his  left  hand 
turns  the  handle  of  the  instrument  until  the  cord  is  sufficiently 
shortened  to  form  a  true  ligation  of  the  tissues  which  it  cu'cum- 
scribes.  The  j)ain  caused  by  this  constriction  may  be  graduated 
by  the  rotation  of  the  handle  of  the  instrument.  "When  in  place 
it  is  either  held  by  an  assistant  or  tied  on  the  halter.  If  the 
animal  proves  to  be  especially  refractory  under  the  infliction,  the 
assistant  should  be  cautioned  against  aggravating  the  trouble  by 
forcibly  dragging  upon  or  jerking  the  instrument,  violence  of 
that  nature  becoming  in  some  instances  the  cause  of  severe  injuries 
to  the  muscular  or  nervous  structures  of  the  lips.  We  have 
ourselves  met  with  several  cases  of  labial  paralysis  resulting  from 
such  an  improper  and  repeated  application  of  the  twitch.  Some- 
times the  length  of  the  wooden  portion  of  the  instrument  is  con- 
siderably reduced,  varying  in  its  apj)lication  in  such  a  way  that 
when  the  open  loop  is  placed  on  the  lip  the  wooden  part  which 
takes  the  place  of  the  handle  is  placed  on  the  lips  through  it,  and 
the  cord  is  twisted  by  turning  it. 

The  barnacles  are  formed  of  two  articulating  branches,  made 
of  either  wood  or  iron,  with  sundi-y  notches  at  one  end  and  a  ring 
at  the  other  to  fit  into  the  notches.  The  degree  of  pressure  re- 
q^uired  is  regiilated  by  shifting  the  ring  until  the  proper  notch  is 


16 


MEANS  OF  RESTBAINT. 


Pig.  2.— Short  Twitch. 


ascertained.  The  iron  instrument  is  severe  in  its  effects,  probably 
more  so  tlian  the  twitch,  but  is  less  easy  of  appHcation.  In  apply- 
ing the  barnacles,  the  surgeon  grasps  the  upper  Hp,  and  placing 


Iron  Barnacles. 


each  of  the  branches  severally  on  opposite  sides  of  the  organ, 
brings  the  ends  together,  immediately  fixing  them  in  place  at  the 
desu-ed  point  of  pressure,  and  secures  them  by  fitting  the  ring 
into  the  proper  notch. 


Fig.  4.— Wooden  Barnacles. 

The  tdooden  barnacles  are  made  with  cu'cular  sharp  ridges  cut 
in  both  branches  in  order  to  intensify  the  pain,  the  ends,  when 
they  are  approximated,  being  secured  by  means  of  cords. 

The  gag  is  a  means  of  derivation  used  principally  in  Central 
Europe.  It  consists  of  a  cord  about  one-quarter  of  an  inch  in 
diameter,  which  is  placed  in  the  mouth,  and  passing  upward  on 
each  side  of  the  face,  is  tied  on  the  top  of  the  head.  This  is  twisted 
to  any  degree  of  tightness  by  means  of  a  small,  round  piece  of 
wood,  which  is  passed  between  the  cheek  and  the  cord,  the  result 
being  excessive  traction  upon  the  commissure  of  the  lips  and  great 


SECURING  SOLIPEDS.  17 


Pig.  5.— The  Gag. 

pain  to  the  animal.  Lacerations  of  the  commissure,  or  wounds  of 
the  skin  at  the  poll  are  to  be  anticipated  if  this  manner  of  pvmish- 
ment  is  not  guardedly  used. 

There  are  besides  these  some  milder  appHances  which  must 
not  be  overlooked.  Among  them  is  the  repeated  pricking  of  the 
tip  of  the  nose  with  a  pin,  and  the  introduction  of  foreign  bodies, 
such  as  musket  balls  in  the  ears.  The  origin  of  this  last  method 
dates  back  to  1607,  when  Httle  round  stones  were  recommended 
for  the  same  object.  When  musket  balls  are  used,  holes  should 
be  di-illed  through  them  for  the  insertion  of  a  string,  in  order  that 
they  may  be  withdrawn  when  necessary. 

B. — Mechanical  or  Restraint  Method. 

The  means  employed  in  this  method  vary  according  to  the  po- 
sition, whether  upright  or  recumbent,  in  which  it  is  desirable  to 
confine  the  animal  during  an  operation. 

STANDING    POSITION. 

The  necessity  of  imposing  restraint  upon  the  patient  while 
under  treatment  in  the  standing  position  arises  not  alone  from  the 
danger  of  injury  to  the  operator  and  his  assistants,  from  the  biting 
and  kicking  of  the  excited  animal,  but  because  he  is  so  thoroughly 
impartial  in  the  distribution  of  his  attentions  that  he  even  requires 
protection  from  his  own  violence,  and  his  own  flesh  must  be  guard- 
ed from  the  contact  of  his  own  teeth. 

They  are  usually  resorted  to  in  order  to  facilitate  operations 
of  comparatively  trifling  importance,  and  which  are  not  of  a  par- 
ticularly painful  nature,  or  are  of  easy  and  rapid  execution,  or 


18  MEANS    OF    KESTEAIXT. 

under  circumstances  when  the  animal  can  be  controlled  by  being 
merely  held  by  the  head  against  a  wall,  or  with  the  hind  quarters 
in  a  corner,  or  perhaps  tied  to  a  wall,  a  post,  or  a  tree.  Certain 
minor  precautions  are  necessary  on  these  occasions.  For  exam- 
ple, the  ground  on  which  they  stand  must  be  smooth,  though  not 
slippery ;  of  a  good  holding  character,  and  neither  too  hard  or  too 
damp,  in  order  to  avoid  falling,  or  sUpping,  or  other  possible  ac- 
cidents. Attention  to  these  matters  will  be  of  great  benefit  to  the 
operator  by  leaving  him  a  good  foothold,  with  facilities  for  free- 
dom of  movement,  and  more  at  hberty  to  guard  himself  against 
his  patient,  unexpected  changes  of  attitude. 

The  means  by  which  the  movements  of  the  head  are  kept  under 
control  are  the  halter,  the  bridle,  the  hridoon  and  the  cavesson — 
instruments  which  need  no  description  here.  If  the  animal  is  left 
unconfined,  the  assistant  having  passed  the  rope  of  the  halter  or 
bridoon  through  his  mouth,  holds  him  close  to  his  head,  places 
himself  in  front  of  him,  or  sUghtly  on  one  side,  and  being  atten- 
tive to  every  movement  the  animal  may  attempt,  anticipates  it,  by 
pnlling  the  head  downwards  if  the  animal  is  about  to  rear,  or  rais- 
ing it  upwards  to  prevent  him  from  kicking  with  his  posterior  legs, 
or  inchning  it  to  one  side  or  the  other,  as  the  animal  moves  it  in 
one  or  the  other  direction. 

An  animal  should  never  be  tied  with  the  halter-rope  in  his 
mouth  or  over  his  nose.  There  is  danger  in  both  methods  of  se- 
rious accidents,  in  case  of  a  violent  backing  or  jerking  of  the 
head.  In  one  case  the  result  might  be  a  section  of  the  tongue, 
and  the  other  might  involve  a  fracture  of  the  maxillary.  For  simi- 
lar reasons  the  bridle  is  also  dangerous.  The  height  at  which  the 
head  should  be  secured  must  vary  with  the  movements  attempted 
by  the  horse.  Thus,  to  prevent  him  from  rearing  or  striking  with 
his  fore  legs,  it  should  be  placed  low,  but  high  when  it  becomes 
necessary  to  guard  against  his  elevating  his  posteriors  in  order  to 
kick  with  his  hind  legs. 

To  protect  his  head  against  possible  self-inflicted  blows  result- 
ing from  his  defensive  struggles,  and  to  prevent  him  from  seeing 
surrounding  objects  likely  to  alarm  him,  are  precautionary  items 
of  not  a  httle  importance,  and  the  employment  of  the  mask  or  cap 
(Fig.  6C)  is  very  effectual  for  that  purpose.  Fractious  patients, 
dangerous  to  handle  and  difficult  to  control,  often  become  perfectly 
quiet  and  thoroughly  docile  on  finding  themselves  involved  in  dark- 


oECUllING   SOLIPEDS. 


19 


tho  Cap.    O,  th9  Cradle. 


ness,  and  submit  to  the  necessary  manipulations  of  the  surgeon  with- . 
out  further  resistance.  When  a  proper  cap  is  unobtainable  a  bridle 
with  blinders  can  be  substituted,  or  a  blanket  placed  over  the  head. 
Biting  the  attendants  may  be  prevented  by  applying  a  muzzle. 


Fig.  7.— Thef^irlnBar. 


20  MEANS    OF    EESTRAIXT. 

and  he  may  be  protected  from  his  own  teeth  by  the  use  of  the 
cradle  (Fig.  60)  or  beads,  or  the  side  bar  (Fig.  TAB).  With  the 
-cradle  around  his  neck,  the  horse  is  prevented  from  carrying  his 
head  on  either  side  ;  its  use,  however,  must  be  carefully  watched 
lest  the  friction  of  the  cord,  which  secures  it  in  place  upon  the 
superior  border  of  the  neck,  should  cause  severe  comphcations  by 
chafing  or  even  cutting  through  the  skin.  Peuch  and  Toussaint 
liave  reported  one  case  of  fatal  tetanus  from  this  cause,  but  no 
such  accident  ought  ever  to  occvu-,  for  the  means  by  which  it  may 
be  avoided  are  easy  and  obvious,  protecting  the  border  of  the 
neck  with  pads.  The  side  bar  prevents  the  flexure  of  the  neck 
toward  the  side  upon  which  it  is  placed,  and  when  in  use  during 
an  operation  is  appHed  on  the  side  occupied  by  the  operator. 
It  is  used  both  singly  (on  one  side  only),  and  doubly  (on  both 
sides). 

The  danger  of  accidents  arising  from  the  unrestrained  mobility 
of  the  head  of  the  animal  being  thus  guarded  against,  those  which 
may  be  caused  by  striking  and  kicking  with  the  feet  are  next  to 
be  considered.  In  many  instances  it  may  be  sufficient  to  simply 
raise  the  foot  from  the  ground,  and  to  keep  it  thus  suspended  by 
holding  the  leg  in  a  position  of  flexure  (Fig.  6). 

No  -^T^olent  measures  are  necessary  in  order  to  obtain  such  con- 
trol over  the  movements  of  the  horse  as  are  consequent  upon  com- 
peUing  him  to  support  his  weight  on  three  legs  only.  The  method 
of  raising  the  foot  and  keeping  it  off  the  ground  is  a  matter  too 
familiar  to  every  stable  hand  to  need  detailed  instructions.  But 
a  little  art  may  be  necessary,  with  a  httle  compulsion  added,  to 
induce  him  to  continue  to  sustain  the  role  of  a  tripod  long  enough 
for  the  purpose  of  the  operator.  But  this  cannot  always  be  de- 
pended on,  and  therefore  when  he  betrays  an  evident  unwilling- 
ness to  submit  quietly  to  such  a  confinement  of  the  foot,  the  com- 
pulsion of  the  ropes  or  straps  must  be  resorted  to.  For  the  fore 
leg  the  strap  is  attached  below  the  fetlock  and  passed  around  the 
forearm,  and  either  buckled  or  held  in  place  by  an  assistant. 
"When  the  rope  is  used  it  is  passed  around  the  coronet,  the  leg 
flexed  and  the  rope  either  passed  round  the  forearm  and  secured 
in  the  same  manner  as  the  strap,  or  thrown  over  the  withers  and 
held  by  an  assistant  on  the  opposite  side  of  the  horse.  For  the 
hind  legs  the  rope,  plaited  rope  or  plate-lonye,  is  necessary  with 
the  hobble.     These  are  applied  in  difierent  ways. 


SECURING    SOLIPEDS. 


21 


Fig.  7a.— Plaited  Kope. 


In  the  first  method  a  hobble  is  placed  on  the  coronet  of  the 
foot  to  be  raised,  with  the  buckle  outward,  and  the  ring  looking 
backward;  then  a  loop  made  at  the  flat  end  of  the  j)late-longe  is 


Fig.  8.— Securing  the  Hind  Foot  with  Eope  and  Hobble. 

passed  around  the  neck ;  the  rope  is  then  carried  along  the  back, 
and  with  a  single  turn  around  the  tail,  is  passed  through  the  ring 
of  the  hobble,  from  within  outward.  PuUing  on  the  rope  raises 
the  foot  and  carries  it  backward,  where  it  is  held  by  the  assistant. 

Second. — Sometimes  the  hobble  is  dispensed  with,  and  the 
rope  is  passed  from  the  neck  straight  to  the  coronet,  where  a 
double  twist  is  made,  and  the  foot  controlled  as  before  (Fig.  9). 

Third.— In  other  cases,  the  plate  longe  is  secured  to  the  tail, 
instead  of  around  the  neck,  conditioned  of  course  upon  whether 
the  tail  is  sufficiently  long  and  furnished  with  haii-  of  the  strength 


22 


MEANS    OF    RESTRAINT. 


Fig.  9.— Securing  one  Hind  Leg  with  Rope  only. 

necessary.  Wlien  matters  are  favorable  in  this  respect,  the 
operator  proceeds  as  follows :  a  loop  being  made  at  some  distance 
from  one  end  of  the  rope,  it  is  laid  flat  on  the  top  of  the  tail,  close 
to  its  origin,  and  the  short  end  being  twisted  around  that  extrem- 


FiG.  10.— A,  The  Twitch.    B.  Side  Bars.    C,  Surcingle.    D,  Securing  Hind  Foot. 
E,  Fixing  the  Eope  ou  the  TalL 


SECURING    SOLIPEDS 


23 


ity  with  from  two  to  four  turns,  and  the  remaining  portion  passed 
through  the  loop,  and  the  other,  or  longer  portion  of  the  rope, 
drawn  taut,  the  knot  is  tied  and  the  plate-louge  thus  firmly 
secured.  As  in  the  two  previous  methods,  by  drawing  upon  the 
longer  end  of  the  rope  the  foot  can  readily  be  raised  and  held  in 
position,  either  with  or  without  the  hobble. 

There  are  occasions,  when,  although  it  may  not  be  required 
to  have  the  leg  and  foot  held  up  for  the  purposes  of  the  opera- 
tion, it  still  becomes  necessary  to  do  so  in  order  to  prevent  the 
animal  from  using  his  feet  as  weapons  of  combat,  or  to  restrain 
him  from  motion. 

The  plate-longe,  and  the  single  or  double  side-line,  with  one 
or  two  hobbles,  are  then  put  in  use,  for  the  purpose  of  either 
raising  the  leg  from  the  ground  and  compelling  the  animal  to 
stand  on  three,  or  again  to  prevent  motion  in  the  posterior  biped. 
For  example,   in  one  case  the  flat  part  of  the  plate-longe  is 


Fig.  11.— Another  Means  of  Using  the  Rope. 

passed  with  a  loop  around  the  coronet  of  the  leg  to  be  kept  steady, 
the  rope  is  then  carried  forward  between  the  fore  legs,  then  on 
the  side  of  the  neck  opposite  to  that  of  the  leg  to  which  the 
plate-longe  is  fixed,  over  the  withers,  back  to  that  side,  and  twisted 
arotmd  itself  behind  the  elbows,  as  it  passes  between  the  fore 
legs  (Fig.  11). 


24 


MEANS    OF    i:i:STRAINT. 


In  otlier  cases  a  large  loop  of  the  j)late-longe  is  thrown  over 
the  neck,  and  the  rope  carried  back  to  the  coronet  of  the  foot  to 


Fj'.S.  13.— Securing  both  Uind  Legs  with  Uobbles. 


SECURING   SOLIPEDS.  25 

be  secured,  and  by  one  or  two  twists  around  itself,  is  brought 
backward,  where  it  is  held  by  an  assistant.  Sometimes  a  single 
hobble  is  placed  on  the  coronet,  and  the  rope  of  this  side-line 
rims  through  its  eye,  which  is  turned  forward  (Fig.  12). 

To  prevent  the  animal  from  kicking  with  both  hind  legs,  a 
King  hobble,  carrying  the  chain,  is  put  on  one  leg,  and  the  chain 
passed  through  the  eye  of  another  hobble  placed  on  the  other 
hind  leg,  and  the  rope  carried  forward  and  secured  as  in  the  case 
of  raising  one  single  foot,  viz.,  between  the  fore  legs,  on  either 
side  of  the  neck,  over  the  withers  and  then  after  being  twisted 
around  itself  back  of  the  elbow,  held  by  an  assistant  (Fig.  19).  In 
some  instances  a  double  side-line  is  used,  the  loop  being  thrown 
over  the  neck,  and  the  ropes  carried  backward,  one  towards  each  hind 
leg,  and  passed  through  the  eyes  of  hobbles  placed  on  them,  and 
returned  forward,  where  they  are  secured  with  a  slip-knot  to  the 
loop  of  the  side-line  on  each  side  of  the  neck. 

For  the  same  purpose,  of  securing  the  two  legs  of  a  biped, 
whether  anterior  or  posterior,  LeGoff  has  invented  a  peculiar 
apparatus,  consisting  of  a  Y-shaped  roi:)e,  single  at  one  end  and 
bifurcated  at  the  other,  each  of  the  three  ends  having  a  running 
noose  or  loop.  If  the  two  hind  legs  are  to  be  secured  the  loops  of 
the  bifurcated  portion  are  placed  on  the  coronets  of  these  legs, 
and  the  loop  of  the  single  portion  secured  on  one  of  the  fore 
legs.  If  on  the  contrary,  the  fore  legs  are  to  be  confined,  the 
arrangement  is  simply  reversed. 

Another  excellent  method  of  limiting  the  movements  of  the 
animal  to  prevent  him  from  kicking,  and  keep  him  quiet,  is  to  take 
a  plate-longe,  and  beginning  on  one  of  his  sides,  at  the  girth,  for 
example,  pass  it  forward  across  one  forearm,  a  little  below  the 
elbow,  in  front  of  him,  on  the  other  side  across  the  other  fore- 
arm ;  then  backward  across  the  thigh,  or  a  little  below  it,  then 
passing  it  back  of  the  animal,  to  the  first  side  across  the  other 
thigh,  to  return  to  the  starting  point  (Fig.  14).  Passing  the  rope 
through  the  eye  of  the  flat  extremity  of  the  plate-longe,  the  legs  can 
be  comparatively  well  kept  together.  To  prevent  the  rope  from 
dropping  too  low,  it  is  thrown  over  the  back  and  secured  on 
itself  on  the  other  side  by  a  knot.  This  part  of  the  rope  over  the 
back  supports  the  two  horizontal  portions  which  run  on  each  side 
of  the  animal  and  keeps  them  in  place. 

This  mode  of  restraint  is  but  a  simplification  of  the  apparatus 


26 


MEANS    OF    BESTRAINT. 


Fig.  14.— Securing  all  the  Legs,  with  Eope  all  around  the  Animal. 


invented  by  Kaabe  and  Lunel — the  hippo-lasso  (Fig.  15).  This 
ajjparatus  is  called  the  straight  jacket  for  horses,  by  the  inventors, 
and  is  composed  of  a  strong  breast-piece  or  Dutch  collar,  and  a 
breeching,  placed  over  the  withers  and  the  croup.  The  breeching 
carries  on  each  side,  firmly  sewn  on,  a  long  strap,  and  at  each 
point,  B,  an  iron  eyelet.  The  breast-piece  at  B,  carries  also  on 
each  side  an  iron  eyelet,  and  on  the  front  strap  a  strong  buckle. 
To  place  it  in  position,  the  Dutch  collar  is  thrown  over  the  neck 
and  the  breeching  laid  over  his  rump.  Both  straps  of  this  part  of 
the  hippo-lasso  are  passed  forward  through  the  iron  eyelet  of  the 
breast-piece  at  B,  back  through  that  of  the  breeching  at  B,  and 
then  forward  again  to  be  buckled,  more  or  less  tightly,  at  b.  The 
length  of  the  strap  of  the  Dutch  collar  piece  which  passes  over  the 
neck,  and  that  of  the  croup,  must  be  regulated  in  such  a  manner 
that  the  horizontal  position  of  the  lasso  is  for  the  fore  legs,  but 
a  little  below  the  forearm,  and  between  the  stifle  and  the  hock 
for  the  hind  legs. 

The  hippo-lasso  is  an  excellent  means  of  restraint,  and  may 
even  be  utilized  for  vicious  animals  upon  which  operations  would 
otherwise  be  impossible,  except  by  throwing  them.     In  shoeing 


SECURIXG    SOLIPEDS. 


27 


Fig.  15.— Hippo-lasso  of  Raabe  &  Lunel. 

vicious  and  clipping  nervous  horses  it  has  given  most  excellent 
results. 

Among  other  varieties  of  apparatus  used  for  controlling 
animals  in  the  standing  position,  are  the  various  machines  known 
as  stocks  or  travis.  They  are  of  many  forms,  and  consist  of  heavy 
wooden  frames,  firmly  secui-ed  in  the  ground,  with  peculiar  arrange- 
ments for  supporting  the  animal  in  slings,  if  necessary.  They 
are  padded  on  the  inside,  for  security  against  injuries  and  have  on 
one  of  their  narrow  sides  a  system  of  iron  bars,  against  which  to 
secure  the  feet  when  the  animal  is  raised  from  the  ground.  The 
stock  illustrated  in  Peuch  and  Toussaint's  work  (Fig.  16),  will 
give  a  good  general  idea  of  one  of  the  most  approved  forms  of  this 
means  of  restraint.  The  stock  of  E.  Winsot  (Figs.  17,  17a  and 
18)  is  another  form,  which  can  be  used  for  securing  the  animal  in 
either  standing  or  laying  position. 


RECUMBENT    POSITION. 

Notwithstanding  the  many  advantages  attending  the  appHca- 
tion  of  the  means  already  described,  devised  for  securing  the 
immobihty  in  the  standing  position  of  animals  undergoing  sur- 
gical treatment,  there  are  circumstances  in  which  their  efficiency 
becomes  wholly  lacking.  Sometimes  it  is  because  of  the  invincible 
restiveness  of  the  animal,  but  more  often  because  of  the  serious 
nature  of  the  pending  operation,  which  may  require  for  its  safe 


MEANS    OF    BESTKAINT. 


Fig.  16.— The  Stock. 


performance  a  degree  of  deliberation  and  an  amount  of  dissection 
of  the  most  painful  character,  with  which  only  the  most  absolute 
passivity,  if  not  complete  unconsciousness,  is  compatible.  In  this 
class  of  cases  the  recumbent  position  in  the  patient  becomes  sim- 
ply an  indispensable  requii'ement. 

To  throio  or  cast  a  horse  signifies  simply  to  apply  the  force 
necessary  to  compel  or  induce  him  to  He  down,  and  to  continue 
in  that  position  during  the  pleasure  of  the  surgeon.  The  forms 
of  compulsion  by  which  the  desired  result  is  to  be  effected  are 
next  to  be  considered. 

It  would  be  improper  to  construe  the  word  "throwing"  as 


SECURING    Sr.LiPEDS, 


Fig.  18.— Laying  a  Horse  Down  with  Winsot's  Stock. 


30  MEANS    OF    KESTRAINT. 

literally  designating  the  act  of  violently  casting  down,  as  in  a 
wrestling  match.  On  the  contrary,  it  must  be  qualified  as  refer- 
ring to  a  method  of  so  manipulating  the  patient  and  directing  his 
movements  as  to  bring  about  a  change  of  posture  with  all  the 
appearances  of  a  voliintary  act  on  his  part,  which  indeed  it  essen- 
tially becomes. 

The  preparation  of  the  bed  upon  which  the  animal  is  thrown, 
and  of  its  location,  will  require  some  judicious  attention  from  the 
surgeon.  A  convenient  place,  with  sufficient  space  to  allow  per- 
fect freedom  of  movement  about  the  patient,  such  as  a  large  yard, 
a  barn  or  an  open  field  will  fulfil  the  requirements.  The  ground 
should  be  smooth,  and,  if  possible,  soft — a  pasture  lot  or  farm- 
yard, or  a  manure  heap  often  offering  good  facilities  for  the  pur- 
pose in  country  practice.  In  any  case  it  should  always  be  covered 
with  a  layer  of  straw,  sawdust  or  tan  bark  of  sufficient  thickness 
to  prevent  a  violent  concussion  when  the  patient  falls,  and  ought 
to  be  sufficiently  wide  to  aUow  him  to  fall  as  nearly  in  its  center 
as  possible.  Its  dimensions  should  be  approximately  from  nine 
to  ten  feet  square. 

An  important  point  in  its  construction  is  that  it  should  be  free 
from  any  hard  foreign  substances,  such  as  stones,  bones,  pieces 
of  wood  or  iron,  etc.,  for  fear  of  contusions  or  other  similar  lesions 
against  any  parts  of  the  body  of  the  patient. 

Several  methods  are  in  use  for  throwing  a  horse,  among  which 
are  the  peculiar  apparatuses  known  as  the  hobbles.  The  ropes 
and  the  operating  tables  are  also  used.  The  previous  preparation 
of  the  animal  for  the  operation  ought  not  to  be  forgotten.  This 
usually  consists  in  a  fast  of  not  less  than  twelve  hours,  and  will 
always  be  found  to  be  a  good  measure. 


A. —  Casting  loith  Hobbles. 

These  are  of  various  kinds.  Some  are  made  of  leather,  others 
of  rope,  but  they  are  aU  constructed  upon  the  same  principle.  The 
English  style,  invented  by  Bracy  Clark  and  afterwards  improved, 
which  are  in  most  general  use,  present  so  many  advantages  in  theu- 
f acihty  both  of  apphcation  and  removal  from  the  legs  after  the  op- 
eration, that  we  shall  limit  oxoc  consideration  to  them  alone  (Fig.  19). 

A  set  is  composed  of  four  hobbles,  a  chain  and  a  spring  hook. 
Each  hobble  is  formed  of  two  straps  of  leather  of  unequal  length, 
the  shortest  (a)  having  attached  on  one  end  a  strong  buckle  (i), 


SECUKING   SOLIPEDS. 


31 


Fig.  19.— English  Hobbles.    A,  Hobble  Unbuckled.    B,  King  Hobble.    C,  Hobble  In 
Position,  with  Rope  through  the  Eye. 


and  at  the  other  an  iron  eyelet,  narrow  and  somewhat  elongated 
(n),  the  eyelet  of  the  longest  (b)  being  somewhat  square  in  form  (e), 
in  order  to  aUow  the  ring  (n)  to  pass  through  it,  and  having  in  its 


Fig.  19a.— Self-locking  Hobbles  of  Prof.  Barker. 


32 


MEANS    OF    RESTRAINT. 


length  a  number  of  holes  to  allow  it  to  be  buckled  with  the  short 
strap.  Three  of  each  set  are  of  this  construction.  The  fourth, 
which  is  the  tnain,  chief  or  king  hobble,  differs  from  the  others 
in  the  form  of  the  iron  eyelet  of  the  shortest  strap.  In  this  hob- 
ble it  is  made  of  a  peculiar  shape,  and  with  a  small  slot, 
through  which  the  chain  is  passed  and  secured  by  a  pin  screw 
running  through  it.  The  chain  belonging  to  this  set  measures 
four  or  five  feet  in  length,  and  has  spliced  at  one  end  a  casting 
rope  some  fifteen  feet  long.  At  the  other  end  the  link  of  the 
chain  is  flattened  and  made  to  slip  easily  through  the  slot  of  the 
main  hobble. 


Fig.  20.— Spring  and  String-IIooks. 

There  are  many  forms  of  spring-hooks  used.  In  our  own 
practice  we  use  two  strong  spring  padlocks,  as  being  of  easier 
apphcation  and  less  liable  to  liberate  the  animal  by  becoming 
loosened  or  breaking. 

Besides  the  set  of  hobbles,  a  long  plate-longe  and  a  Bernardot 
&  Buttel  apparatus  are  necessary.  This  consists  of  a  wide  and 
strong  surcingle,  having  on  both  sides  two  straps,  joined  together 
in  front,  and  a  strong  halter,  which  from  the  nose-band  carries 
another  strap,  which  passes  in  front  of  the  head,  between  the  ears, 
through  an  iron  ring  on  the  pole-band  of  the  halter,  and  is  to  be 
buckled  to  the  single  strap  of  the  surcingle.  By  shortening  this 
strap,  the  head  and  neck  are  placed  and  kept  in  as  much  exten- 
sion as  may  be  desired. 

PreUminaries  being  completed  and  instruments  ascertained  to 
be  in  efficient  condition,  the  horse  is  placed  at  the  side  of  the  bed ; 
and  we  may  here  repeat  that  the  manipulations  which  are  next  to 
succeed  are  not  designed  to  throw  him  off  his  feet  with  a  violent 


SECURING   SOLIPEDS. 


33 


Fig.  21.— Bernardot  &  Buttel  Apparatus. 


shock,  but  simply  to  place  him  in  a  posture  of  such  discomfort, 
and  so  to  disturb  the  center  of  gravity  that  lying  down  becomes 
an  instinctive  act,  and  is  done  voluntarily,  in  order  to  avoid  the 
act  of  falling ;  it  may  be  termed  a  voluntary  compulsion. 

When  brought  to  the  bed,  a  cap  is  placed  over  his  head,  and 
all  the  hobbles  are  applied,  simultaneously  if  possible,  by  four 
assistants  acting  in  concert.  They  should  carefully  obsei've  that 
the  large  buckle  of  each  hobble  is  placed  on  the  outside  of  the 
leg,  and  that  the  eyes  of  the  straps  are  turned  toward  the  center 
of  gravity  of  the  animal,  those  of  the  front  hobbles  looking  back- 
ward, and  those  of  the  hinder  hobbles  looking  forward.  The 
chief  hobble  must  be  placed  on  the  fore  or  hind  leg  of  the  side 
opposite  to  that  on  which  the  animal  is  to  he. 

The  application  of  the  hobbles  on  a  timid  and  restive  horse  is 
not  always  an  easy  matter.  Kemembering,  perhaps,  some  similar 
experience  at  some  former  period,  he  rebels,  resists  and  kicks  as 
a  natural  consequence.  If  speaking  soothingly  and  kindly,  and 
employing  the  usual  tranquihzing  and  assuring  processes,  with 
the  raising  of  one  of  the  fore  feet,  fails  to  quiet  and  control  him, 
a  twitch  is  placed  on  his  nose  and  left  on  until,  at  a  preconcerted 
moment,  the  hobbles  are  put  in  place ;  quickly,  but  as  noiselessly 
as  possible,  the  chain  is  passed  through  the  ring  of  the  chief  hob- 
ble— on,  say  the  fore  leg  for  facility  of  description — then  through 
the  ring  of  the  other  fore  leg,  back  to  the  ring  of  the  hind  leg  of 


34 


MEANS    OF    RESTRAINT. 


the  same  side,  through  the  ring  of  the  other  hind  leg,  and  back 
to  the  slot  of  the  main  hobble,  where  it  is  secured  by  the  pin- 
screw.  The  Bernardot  &  Buttel  apparatus  is  then  put  in  place 
and  buckled  by  an  assistant,  wdth  the  surcingle  on  the  side  of  the 
patient  opposite  to  that  on  which  he  is  to  be  made  to  lie.  Previ- 
ous to  this,  another  assistant  will  have  passed  a  long  rope  around 
the  body  of  the  animal  a  little  back  of  the  withers,  and  with  still 
another  holds  it  on  what  will  be  the  under  side  when  the  patient 
hes  down.  Still  another  assistant  is  placed  at  his  head,  to  aid  the 
one  who  holds  it,  while  yet  another  grasps  the  tail,  and  two  others 
seize  the  casting  rope. 

The  second  step  of  the  operation  is  to  reduce  the  animal's 
base  of  support  as  much  as  possible,  by  bringing  the  four  feet 
together.  To  do  this,  the  operator,  standing  in  front  of  the  as- 
sistants who  hold  the  casting  rope,  has  each  hind  leg  in  succession 
raised  sHghtly  from  the  ground  and  carried  forward  by  the  assist- 
ant having  it  in  charge,  a  gentle  traction  being  made  at  the  same 
time  upon  the  casting  roj)e,  in  order  to  shorten  the  length  of  the 
chain  passing  through  the  hobbles,  the  assistants  at  the  head 
meanwhile  gently  backing  the  animal  still  more  to  reduce  his  area 
of  support,  vuitH  the  equilibrium  is  so  nearly  lost  that  the  animal 


Fig.  22.— Horse  about  to  be  Cast. 


SECURING    SOLIPEDS.  35 

instinctively  abandons  tlie  effort  to  keep  his  feet,  and  assumes  the 
recumbent  posture  in  order  to  avoid  the  shock  of  a  heavy  fall. 

H.  Bouley  recommends  that  the  first  movement  in  this  final 
step  should  be  an  attemj)t  to  back  the  horse,  in  order  to  move  the 
fore  legs  first,  and  then  to  bring  the  hind  legs  forward,  if  the  base 
of  support  is  stni  too  broad.  The  twitch  should  now  be  removed ; 
in  fact,  the  most  prudent  plan  would  be  to  remove  it  the  moment 
the  hobbles  are  in  place 

The  final  step  of  the  act  of  Hteral  throwing  or  casting  being 
accomplished,  the  last  indication  remaining  to  be  fulfilled  is  to 
secure  the  patient  in  the  most  favorable  i:)Osition  for  the  surgeon 
to  perform  the  important  work  of  which  all  that  has  been  iinder- 
taken  has  been  but  preliminary.  It  is  properly  the  permanent 
(for  the  time  being)  adjustment  of  the  body  in  such  a  manner  as 
to  allow  the  surgeon  the  best  possible  access  for  all  his  manipula- 
tions to  the  region  which  is  to  be  the  seat  of  his  dissections 
and  other  operative  movements,  without  any  unsteadiness  or 
opposition. 

Bouley's  directions  for  this  purpose  are  that  the  operator, 
watching  for  the  right  moment,  as  the  horse  begins  to  totter, 
gives  orders  to  the  assistants  having  charge  of  the  ropes  acting 
on  the  body,  the  tail  and  the  head,  by  a  prompt  and  simultaneous 
action,  to  pull  in  the  direction  of  the  side  on  which  the  animal  is 
to  lie,  and  to  those  at  the  casting  rope  to  pull  firmly  but  not 
harshly  in  the  opposite  direction,  while  he  himself  pushes  the 
body  of  the  animal  towards  the  bed.  By  this  arrangement  of 
opposing  tractions  the  casting  is  easily  efi'ected ;  but  unless  the 
assistants  act  in  perfect  concert,  and  especially  if  the  casting  rope 
be  draT\Ti  too  rapidly  and  suddenly,  the  animal  will  be  raised  from 
the  ground  with  a  sudden  lift,  to  fall  so  heavily  on  the  bed  as  to 
possibly  subject  him  to  the  risk  of  sustaining  severe  injuries. 

Bouley  remarks  on  this  point:  "An  animal  is  properly  cast 
only  when,  bending  his  knees,  he  lies  down  softly  and  easily  on 
his  side,  bringing  to  the  ground  successively  the  shoulder,  the 
ribs  and  the  hind  quarters;  or  again  when,  the  fall  beginning 
from  behind,  the  order  is  exactly  reversed." 

Once  down,  the  forcible  traction  upon  the  chain  brings  the 
four  legs  in  close  proximity,  the  spring  hooks  or  padlock  passing 
through  the  link  nearest  to  the  ring  of  the  hobble  through  which 
the  chain  passes,  coming  out  last.     To  provide  against  the  possi- 


36 


MEANS    OF    RESTRAINT. 


ble  breaking  of  that  portion  of  the  chain  which  embraces  the  four 
hobbles,  Peuch  &  Toussaint  advise  the  passing  of  the  casting  rope 
and  chain  a  second  time  through  the  rings  of  every  hobble  before 
it  is  secured  with  the  spring  hooks.  The  animal  being  down,  the 
straps  of  the  Bernardot  &  Buttel  apparatus  are  buckled,  and  the 
head  well  extended  on  the  neck.  The  use  of  this  apparatus  con- 
siderably diminishes  the  difficulties  involved  in  the  contention  of 
the  head.  Before  its  introduction,  two  assistants  were  required 
to  keep  it  in  extension  and  comparatively  motionless ;  and  even 
then  the  results  were  not  always  easily  reached  nor  accidents 
avoided,  whereas,  with  this  halter  and  surcingle  arrangement  a 
single  strong  assistant  is  sufficient  to  secure  control  of  the  head ; 


FlO.  33.— Horse  Thrown  and  Secured  by  Bernardot  &  Buttel  Apparatus. 


SECURING    SOLIPEDS. 


37 


and  it  has  the  advantage,  besides,  of  "  preventing  fractures  of  the 
vertebral  column,  ruptui-e  of  the  diaphragm,  and  rupture  of  in- 
ternal viscera." 

In  some  exceptional  cases  the  surgeon  will  be  obHged  to  im- 
provise his  hobbles.  This  may  be  done  by  fastening  four  ropes 
of  suitable  length  around  the  coronets,  allowing  sufficient  room 
for  the  passage  of  the  casting  rope  between  the  hobbles  and  the 
Bkia,  or  again  placing  an  iron  ring  through  these  loops  of  rope, 
which  are  secured  by  a  knot  on  the  outside  of  the  leg,  as  suggest- 
ed by  'Mi:  Dneubourg. 

The  removal  of  the  hobbles  and  of  the  other  aj)paratus  em- 
ployed ui  casting  the  animal,  demands  similar  care  and  attention 
to  that  which  was  requu-ed  to  put  them  on.  "While  the  Bernardot 
&  Buttel  surcingle  is    unbuckled,    the   assistant  loosening   the 


U^'.il,.M,    ,,,/M/i,. 


Fig.  24.— Improved  Hobbles  of  Dneubourg. 

straps  of  the  cap,  and  ready  to  remove  it  at  a  moment's  notice, 
the  operator  placing  himself  facing  the  soles  of  the  feet,  in  order 
to  be  out  of  dangei',  cautiously  unscrews  the  screw-pin  which 
fastens  the  chain  to  the  principal  hobble,  and  removes  it,  when  aU 
the  hobbles  becoming  loose,  are  removed,  and  the  animal  being 
freed  from  all  restraint,  is  allowed  to  rise. 

While  the  animal  is  rising  it  will  be  but  prudent  in  the  by- 
standers to  allow  him  all  the  scope  he  may  choose.  The  action  is 
sudden  and  somewhat  violent,  and  he  may  move  his  hind  legs 


38  MEANS    OF    KESTKAINT. 

with  a  sudden  jerk  which  may  throw  the  hobbles  off  with  force  suf- 
ficient to  severely  hurt  some  unguarded  spectator  upon  whose  per- 
son they  might  infringe.  We  have  been  witness  to  such  an  oc- 
currence, when  they  were  thrown  a  distance  of  twenty  feet,  with 
violence  sufficient  to  inflict,  possibly,  dangerous  injuries. 

An  animal  thrown  and  secured  as  has  been  described  is  in  a 
suitable  position  for  the  majority  of  operations,  such  as  those 
about  the  head  and  neck,  of  the  body,  or  of  the  up^Der  part  of  the 
legs.  But  in  many  cases,  it  is  necessary  to  fix  a  leg  in  a  peculiar 
position  either  to  expose  a  given  region  of  the  body,  or  when 
the  limb  itself  becomes  the  seat  of  operation.  The  action  of  se- 
curing the  animal  in  the  recumbent  position  is  one  of  great  im- 
portance, and  none  of  its  details  ought  to  be  overlooked.  And 
there  are  several  points  to  which  we  have  already  referred  in  our 
introduction,  which  may  be  again  noticed  with  advantage.  Bear- 
ing in  mind  the  accidents  which  may  result  from  keeping  the 
horse  in  a  state  of  painful  passivity,  and  his  instinctive  struggles 
to  free  himself,  not  to  mention  the  painfulness  of  the  constrained 
posture  itself,  the  inference  is  palj)able  that  it  is  incumbent  on  the 
surgeon  to  release  the  suffering  patient  from  his  trying  constraint 
at  the  earliest  moment  consistent  with  the  proper  completion  of 
the  OiDeration.  Again,  in  securing  the  legs,  care  must  also  be 
taken  that,  although  a  given  position  of  a  leg  may  facilitate  the 
movements  of  the  operator,  it  is  not  justifiable  if  there  is  another 
mode  of  securing  the  same  object  by  means  more  comfortable 
and  less  dangerous  to  the  patient,  as  well  as  easier  for  the  surgeon. 

An  experience  of  many  years  has  taught  us  that  six  principal 
modes  of  fixing  an  animal's  leg,  fulfil  all  necessary  requirements, 
and  that  the  special  purposes  and  effects  of  these  are  such  as  to 
forbid  their  modification. 

In  considering  these  six  specific  modes,  it  will  promote  facility 
of  description  if  the  reader  will  follow  our  references  to  the  dif- 
ferent legs  on  a  sort  of  mental  diagram  which  by  a  mode  of  ab- 
breviation by  initials  will  designate — supposing  the  animal  to  be 
thrown  on  the  near  side — the  near  anterior  as  N.A.;  the  off 
anterior  as  O.A.;  the  near  hind  as  N.H.;  and  the  off  hind  as  O.H. 

First  'position — Exposing  the  inside  of  the  N.A.  leg. — A  loop 
of  the  plate-longe  is  secured  on  one  of  the  fore  legs,  above  the 
knee,  say  the  off  leg,  carried  in  front  of  the  near  leg,  imder  it, 
back  and  between  the  fore  legs,  always  above  the  knee,  to  return 


SECURING   SOLIPEDS. 


39 


Pig,  25.— 1st  Position.    Neurotomy. 

to  the  starting  point,  around  the  off  leg  again,  back  to  and  be- 
tween the  legs,  thus  forming  a  complete  figure  8.  This  is  re- 
peated twice  or  three  times,  when  a  turn  around  all  the  crossings 
of  the  rope  between  the  legs  ties  up  all  the  twists  of  the  rope  and 
a  double  slip-knot  is  made  on  the  forearm  of  the  ofi'  fore  leg. 
Both  legs  thus  secured,  the  near  leg  is  released  from  the  hobble, 
and  carried  forward  by  an  assistant  pulling  on  it  with  a  rope  tied 
around  the  foot. 

For  reasons  already  stated,  we  consider  this  position  as  the 
only  one  justifiable  for  neurotomy  on  the  inside  of  the  off  leg,  or 
for  tenotomy.  Firing  on  the  inside  of  the  coronet  for  ringbone, 
or  along  the  tendons,  might  also  be  performed  in  this  position. 

Second  position — Securing  the  off/ore  on  tlie  off  hind  leg. — The 
loop  of  the  plate-longe  is  placed  on  the  O.A.  leg  about  the  middle 


Fig.  ae.— ad  Position.    Ist  Step. 


40 


MEANS    OF    RESTRAINT. 


of  the  cannon  region,  from  there  carried  backwards  over  the  O.H. 
leg,  above  the  hock,  between  both  hind  legs,  and  forward,  be- 
tween the  fore  legs  and  reflected  back  over  the  forearm,  about 
its  middle,  when  it  is  given  to  an  assistant  stationed  at  the  back 
of  the  animal.  An  assistant  is  placed  in  front  of  the  animal, 
kneeling  on  the  bed,  and  prevents  the  rope  which  passes  in  front 
and  over  the  forearm  from  slipping  down  too  rapidly.  The  leg 
being  released  from  the  hobble,  the  operator  holding  it  carries  it 
backward,  while  the  assistant  at  the  back  pulls  slowly  but 
steadily  on  the  rope,  the  action  of  this  lever  of  the  first  kind, 
with  its  fulcrum  on  the  O.H.  leg,  the  resisting  power  at  the  foot 
of  the  animal  and  the  moving  power  at  the  forearm  of  the  off, 
moves  and  draws  the  leg  backward  until  it  reaches  the  cannon 
bone  of  the  hind  leg.  At  that  moment,  steadily  holding  every- 
thing in  place,  the  rope  that  is  passing  above  the  hock  on  the 
near  hind  leg  is  allowed,  cautiously,  to  slij)  below  the  hock,  and 
the  near  fore  leg  is  then  brought  to  the  middle  of  the  near  hind 
cannon  bone,  where  it  is  secured  with  a  double  figure  8.  Other  sur- 
geons secure  the  fore  leg  above  the  hock  as  in  the  plate  we  borrow 
from  Peuch  and  Toussaint  (Fig.  27).  The  danger  of  injury  to 
the  tendo- Achilles  has  caused  us  to  change  that  position  to  the  one 


Fig.  27.— 2d  Position.    2cl  Step. 


SECUKING    SOLIPEDS. 


41 


above  described.  In  this  position  the  inside  of  the  N.A.  leg  is  ex- 
posed, and  it  can  be  fired,  either  for  disease  of  the  knee  or  of  the 
tendons  and  bursse.  All  operations  upon  the  foot  of  the  O.A.  can 
be  performed  except  those  required  on  the  inside  of  that  foot, 
such  as  those  for  inside  quarter-crack,  complicated  suppurating 
corn  or  inside  cartilaginous  quittor. 


Fig.  28.— 3d  Position.    Securing  Upper  Hind  to  Upper  Fore  Leg. 


Third  position. — Securing  the  off  hind  tiponthe  corresponding 
fore  leg. — In  this  the  rope  is  first  secured  in  the  middle  of  the  off 
hind  cannon  region,  carried  forward  and  over  the  forearm,  above 
the  knee,  in  front  of  the  forearm,  back  between  the  fore  legs, 
between  the  hind  legs  and  over  the  near  hind  leg,  above  the 
hock,  to  the  assistant  stationed  at  the  back  of  the  animal.  Re- 
moving the  leg  from  the  hobble,  and  pulling  on  the  rope  the 
near  hind  leg  is  brought,  by  the-  same  method,  to  the  middle  of 
the  off  fore  cannon,  where  it  is  secured  with  a  figure  eight  twist  of 
the  rope.  In  this  operation  the  inside  of  the  near  hind  leg  is  ex- 
posed from  the  hock  down,  and  in  that  position,  operations  on  the 
inside  of  the  hock  can  be  performed,  such  as  firing  for  spavin, 
thorough-pins,  curbs,  and  cunean  tenotomy,  as  well  as  fii'ing  on 
the  inside  of  the  tendons,  or  even  tenotomy.  As  far  as  the  off 
hind  leg  is  concerned,  only  operations  on  the  foot  are  justified, 
with  the  exception  of  those  on  the  inside  of  that  part  of  the  leg. 

Fourth  piosition — Securing  the  near  fore  on  the  off  hind  leg. — 
The  rope  is  secured  by  a  loop  on  the  middle  of  the  cannon  of  the 
near  fore  leg,  which  rests  directly  on  the  bed,  carried  backward 
over  the  off  hind  leg  above  the  hock,  back  between  the  hind  legs, 


42 


MEANS    OF    RESTRAINT. 


Fig.  29.— ith  Position.    Securing  Under  Fore  on  Upper  Hind  Leg. 

forward  ^mder  the  forearm  of  the  near  fore  leg,  between  the 
fore  legs  and  back  to  the  assistant  at  the  back  of  the  animal.  In 
this  action  it  again  becomes  a  lever  of  the  first  kind,  with  the 
fulcrums  above  the  hock,  the  resistance  at  the  lower  part  of  the 
near  fore  leg  and  the  moving  power  at  the  forearm.  The  leg  is 
drawn  from  its  deep  position  to  a  superficial  one,  and  secured 
with  a  figure  eight  on  the  middle  of  the  near  hind  cannon,  and 
not  above  the  hock,  for  reasons  already  considered.  This  posi- 
tion is  only  justifiable  for  operations  on  the  inside  of  the  near 
fore  foot,  such  as  complicated  quarter- crack,  complicated  suppu- 
rative corns,  inside  cartilaginous  quittor,  and  the  like.  The  pe- 
culiar awkwardness  of  this  position,  in  which  the  leg  is  carried 
in  excessive  adduction  subjects  the  animal  to  the  danger  of  severe 


Fig.  30.— 5th  Position.    Securing  Under  Hind  on  Upper  Fore  Leg. 


SECURING    SOLIPEDS. 


43 


lesions  in  the  axillary  region,  and  it  is  justifiable  only  in  the  cases 
specified. 

Fifth  position — Securing  the  near  hind  on  the  cannon  of  the 
off  fore  leg. — The  rope  is  first  tied  up  by  a  loop  on  the  middle  of 
the  near  hind  cannon  bone,  forward  over  the  forearm  of  the  off 
fore  leg,  between  the  fore  legs,  and  back  to  under  the  near  hind 
leg,  between  the  hind  legs  and  to  the  back  of  the  animal,  where  it  is 
held  by  an  assistant.  The  leg  is  again  drawn  from  under  him,  is 
steadily  brought  to  below  the  knee  of  the  off  forearm  and  secured 
as  in  the  other  positions.  In  this  position  the  only  operations 
to  be  performed  are  those  on  the  inside  of  the  digital  region,  or 
rather  of  the  foot  of  that  leg. 


Fig.  31.— 6th  Position. 


Sixth  position — Securing  the  off  hind  leg  near  the  neck  or 
shoxdder  of  that  side  of  the  body. — The  rope  is  tied  up  by  a  loop 
around  the  coronet  of  the  off  hind  leg,  that  is  below  the  fetlock, 
carried  forward  toward  the  superior  border  of  the  neck,  under 
the  neck  and  then  toward  the  inferior  border  of  that  region,  back 
over  the  whole  length  of  the  animal  to  the  front  of  the  hind  legs, 
between  these  and  over  the  tibial  region  of  the  off  hind  leg,  where 
an  assistant  holds  it  to  the  back.  Other  assistants,  pulling  on 
the  rope,  and  making  it  sHde  as  it  passes  on  the  borders  of  the  neck, 


44 


MEANS    OF    KESTKAINT. 


the  operator  carries  the  leg  forward  until  it  reaches  the  outside  sur- 
face of  the  shoulder,  or  the  lateral  parts  of  the  neck,  where  the  rope 
is  secured  by  a  double  twist  and  knot  around  the  coronet  of  the 
near  hind  leg  displaced.  This  awkward  and  painful  position  is 
for  operations  in  the  inguinal  region,  including  castration,  in- 
guinal hernia,  removal  of  champignon,  amputation  of  the  jDenis, 
or  removal  of  tumors. 

When  the  operations  which  have  necessitated  these  various 
positions  have  been  completed,  the  leg  which  has  been  restrained 
should  be  returned  into  its  proper  hobble,  and  this  should  be 
done  slowly  and  carefully,  avoiding  any  unnecessary  motions  or 
noises,  and  the  animal  relieved  of  his  means  of  restraint  as  in  all 
other  operations. 


Fig.  32.— Side  Bar  Hobbles. 

In  a  few  instances,  however,  aside  from  these  various 
modes  of  securing  individuals,  the  surgeon  has  recourse  to 
the  side  bar  hobbles,  which  carries  a  hobble  of  its  own  at  each 
end,  one  hobble  being  fixed  on  a  fore,  the  other  on  a  hind  leg. 
Some  of  the  Enghsh  veterinarians  are  using  the  cross  hohhles, 


which  has  the  advantage  of  being  adapted  for  use  upon  legs 
diametrically  opposite,  such  as  the  near  fore  and  the  oflf  hind  legs, 
and  vice  versa. 

B. —  Casting  with  ropes. 

The  hobbles  are  not  the  only  kind  of  apparatus  devised 
for  throwing  horses,  nor  are  they  all  made  according  to  the 
English  pattern,  although  the  same  general  princij^les  pre- 
vail in  all.     Eopes  in  the   form  of   side  lines,  either   single  or 


SECURING    SOLIPEDS. 


45 


double,  are  often  substituted  for  hobbles,  and  for  many  varieties  of 
these  special  claims  are  made  by  their  inventors,  or  by  those  who  give 
them  their  jDreference,  and  use  them  in  their  practice.  Without 
entering  into  the  consideration  of  the  comparative  merits  of  these 
various  methods,  which  vary,  not  only  in  nearly  every  country  of 
the  world,  but  even  in  different  sections  of  the  same  country, 
there  is  a  mode  of  their  application,  upon  which  we  have  a  word 
of  comment  to  offer.  This  is  the  mode  with  a  single,  and  that 
with  a  double  rope. 

(1st.)  With  a  single  rope. — This  is  the  simplest  mode  of 
casting,  but  it  is  also  the  least  safe.  It  is  the  oldest  of  the 
methods  in  use,  but  has  in  our  days  been  more  or  less  modified 
and  improved.  The  method  of  Rohard  seems  to  be  as  perfect  as 
any  of  them.  In  this,  a  rope  from  twenty  to  twenty-five  feet  in 
length  is  necessary.  The  horse  being  placed  near  the  bed  where 
he  is  to  be  thrown,  is  held  in  the  ordinary  manner.  If  he  is  to  he 
on  the  near  side,  the  operator  is  placed  on  the  right,  near  the 
shoulder  with  the  rope,  in  which  is  a  knot  about  six  feet  from  its 
end,  which  Rohard  calls  the  ring  knot  (a),  and  immediately  below 
it  is  another,  called  the  stoj^j^hig  knot  (b),  through  which  the  rope 
will  run.     "In  this  way,"  says  Rohard,  "there   is  a  large  loop 


FIG.  34.— Applioatuu  of  too  Kohard  Method. 


46 


MEANS    OF    EESTKAINT. 


formed,  wliicli  is  thrown  over  the  neck,  while  both  knots  made 
he  a  httle  below  the  point  of  the  shoulder."  Taking  with  the  free 
portion  of  the  rope,  a  twist  round  both  forearms,  passing  behind 
them  first,  then  forward  across  the  near  fore  leg,  in  front  of  both 
fore  legs,  and  backward  across  the  off  fore  leg,  over  the  rope,  it 
is  carried  across  the  abdomen,  to  the  near  hind  coronet,  which  it 
surrounds  from  without  inwards,  to  be  brought  back  to  the 
posterior  part  of  the  withers  on  the  near  side,  where  the  operator 
takes  hold  of  it.  Then  by  degrees  slowly  puUing  on  the  rope, 
and  making  the  animal  raise  his  near  hind  leg  by  quietly  urging 
him,  this  leg  is  carried  forward,  with  a  uniform  movement,  until 
at  one  moment,  the  animal  attemj)ting  to  resist  or  struggle, 
the  assistant  at  the  head  carries  it  toward  the  bed,  the  operator 
pressing  with  his  body  against  that  of  the  animal,  until  he  slowly 
settles  down  without  injui-y  on  his  side.     To  fix  the  leg  definitely. 


Fig.  35.— Animal  Secured  by  the  Rohard  M-ethod. 

one  begins  by  the  near  hind  leg.  Making  a  double  twist  of  the 
rope  around  the  coronet  of  that  leg,  this  is  carried  towards  the 
loop  which  passes  around  the  neck,  and  is  there  secured  by  a 
double  knot  (a),  and  carried  back  to  the  off  hind  leg,  which  is  then 
carried  far  forward  and  secm-ed  to  the  same  collar  loop,  with  a 
single  knot  (h).  To  release  the  animal,  it  is  merely  necessary  to 
tmtie  the  stopping  knot,  when  the  rope  becomes  loosened  from 
the  legs. 


SECURING    SOLIPEDS.  47 

(2d. )  With  double  side  lines,  or  two  ro2)es. — This  is  dene  by  means 
of  a  long  rope,  doubled  in  its  middle,  and  having  a  knot  made  in 
such  away  as  to  form  a  loop  large  enough  to  be  drawn  over  the 
head  and  neck  of  the  animal ;  the  two  ends  below  the  knot  are 
then  passed  in  front  of  the  chest  and  between  the  fore  legs, 
carried,  one  to  each  hind  leg,  aroiind  the  coronet,  turning  it  once 
around  the  main  roj)e,  and  passed  on  the  collar  loop  from  within 
outwards,  to  strong  assistants  standing  on  each  side  of  the 
animal.  By  steady  pulling  both  hind  legs  are  carried  forward, 
until  the  animal  loses  his  balance  and  settles  on  his  haimches, 
when  a  strong  efibrt  of  the  assistant  at  the  head  brings  him  down 
on  the  bed.  The  hind  legs  are  secured  to  the  collar  loop  with 
the  ends  of  the  rope,  and  the  fore  to  the  hind  legs  in  the  same 
manner. 

The  various  methods  of  casting  which  we  have  been  consider- 
ing, with  hobbles  and  with  ropes  are,  as  we  have  before  said,  not 
the  only  plans  recommended.  Almost  every  country  <  f  EurojDe, 
while  also  using  the  hobbles,  has  a  fashion  of  its  own  in  which  the 
ropes  are  utilized,  and  as  to  the  fact  of  their  widespread,  if  not 
universal  use,  it  would  seem  that  not  a  few  veterinarians  of  exten- 
sive practice  have  originated  and  employed  special  methods  of 
their  own  devising,  for  which  they  claim  more  or  less  superiority. 
Among  those  recommended  in  this  country,  we  may  mention  the 
apparatus  of  Mr.  IVIiles,  which  he  has  used  for  years  in  his  exten- 
sive practice  as  castrator.  Dr.  Wm.  Dougherty,  of  Baltimore,  has 
sent  us  a  set  of  rope-hobbles  and  side-line,  which  upon  personally 
testing  we  are  able  to  recommend  as  possessing  important  points 
of  excellence,  especially  in  casting  young  colts  for  castration.  For 
further  light  and  broader  information  on  this  subject  we  must 
refer  our  readers  to  the  standard  authors  by  whom  it  has  been 
discussed  in  the  French,  German,  Danish  and  Russian  tongues, 
feeling  at  the  same  time  quite  confident  that  the  general  rules 
which  we  have  suggested  and  illustrated  for  the  performance  of 
the  operation  of  casting  are  sufficient  to  guide  any  intelhgent 
oi^erator  through  all  the  steps  of  the  proceedings. 

C. — Casting  on  the  Operating  Table. 

The  necessity  of  employing  such  a  number  of  assistants  in 
throwing  a  horse,  with  the  difficulties  often  encountered  in  con- 
ducting all  the  steps  of  the  operation,  and  the  accidents  which 


48 


MEANS    OF    EESTEAINT. 


too  often  accompany  its  execution,  have  led  to  the  invention  of 
other  means  of  accompHshing  the  object  in  which  the  objections 
to  the  old  method  are  sought  to  be  obviated.  It  was  with  this  view 
that  the  operating-beds  of  Lafosse  in  France  and  Hart  in  Wurtem- 


FiG.  36.— Wall-bed  of  Fromage  de  Feugre 

burg  were  contrived.  The  wall-bed  of  Fromage  de  Feugre  pos- 
sessed many  advantages,  but  was  abandoned  on  accoimt  of  its 
complicated  structure.  Of  late  years,  however,  several  other 
forms  of  operating  tables  have  been  devised,  of  which  one  espe- 
cially is  highly  commended  by  Eui'opean  authors.  It  is  that  of  Mr. 
J.  Daviau  which  consists  of  a  broad  and  heavy  table,  furnished  with 
pads,  surcingles,  hobbles,  ropes  and  other  necessary  appurten- 
ances for  seciu'ing  the  animal,  and  which  is  moved  by  a  pecuhar 
crank  arrangement  which  permits  its  adjustment  in  any  required 
position,  from  the  horizontal  to  the  vertical,  and  by  which  it  may 
be  turned  down  flat  upon  an  u^on  frame.  The  apparatus  is  placed 
solidly  on  the  ground,  or  can  be  made  movable  by  a  set  of  low 
wheels  attached  to  the  heavy  wooden  frame  upon  which  the  table 
and  the  crank  are  supported. 

Mr.  Daviau  claims  for  his  invention:  1st.  That  it  obviates  "aU 
the  comphcations  "  accompanying  the  ordinary  system  of  throw- 
ing. 2d.  It  allows  "  the  easy  and  comfortable  rising  of  the  horse  " 
after  the  operation,  without  danger.  3d.  It  gives  entire  security 
to  the  operator,  who  can  perform  his  task  alone  and  without  the 


SECUBING   SOLIPEDS. 


49 


50 


MEANS    OF    RESTRAINT. 


SECURING    SOLIPEDS. 


51 


52 


MEAJNS    OF    RZSTRAI>'T. 


FIG.  40. -Hodgson  &  Magee'e  Table.    Back  View ;  showing  the  working  of  puUey  to 
draw  the  table  down. 


SECUKINfi    S(JLIPEDS.  53 

need  of  assistant.  4th.  No  assistants  are  needed  to  be  exposed 
to  danger,  and  the  responsibility  of  the  operator  is  diminished. 
5th.  Economy  of  time.  6th.  Economy  of  material  and  space  for 
the  performance  of  the  ordinary  operation  of  casting. 

In  this  country  several  forms  of  tables  are  in  use.  Those  of 
Dr.  Tiffany,  Price  and  others,  all  of  which  are  constructed  somewhat 
upon  the  same  principles  with  respect  to  the  action  of  an  iron 
crank  to  control  the  position  of  the  table.  Doctors  Hodgson  & 
Magee,  both  veterinarians  of  New  York,  have  invented  a  table  which 
for  simplicity  seems  to  siu*pass  any  one  we  have  yet  seen  (Fig.  40). 
Like  the  others,  it  has  slings,  ropes,  hobbles,  pads,  etc.,  but  dif- 
fers from  them  in  two  important  particulars.  The  first  is  the 
manner  in  which  the  table  is  lowered  and  raised ;  the  second,  the 
manner  in  which  the  hobbles  are  secured  and  made  immovable. 
In  the  middle  of  the  superior  border  of  the  table,  and  directly 
below  it  on  the  posterior  face,  are  two  solid  iron  rings.  In  the 
ceiling  of  the  operating  room,  or  on  the  cross-piece  of  the  frame 
in  which  it  is  enclosed,  and  directly  opposite  that  in  the  border  of 
the  table  there  is  another.  Another  is  fixed  in  the  floor  some  dis- 
tance back  of  the  frame  upon  which  the  table  rests  when  in  a 
horizontal  position.  To  these  rings  two  systems  of  j)ulleys  are 
attached,  one  connecting  that  in  the  ceiling  with  that  in  the  bor- 
der of  the  table ;  the  other  connecting  the  ring  on  the  posterior 
face  of  the  table  with  that  in  the  floor.  Besides  this,  under  the 
table  are  two  strong  u'on  eyelets  through  which  chains  are  passed, 
which  at  one  end  are  secured  to  the  hobbles  by  openings  through 
the  table,  and  at  the  other  are  secm-ed  from  slipping  through  the 
ring  by  a  wide  T  arrangement,  secured  on  the  last  link.  These 
chains  measure  the  distance  which  exists  between  the  rings  on  the 
floor  and  the  table  when  in  a  horizontal  jDOsition. 

When  the  horse  is  brought  alongside  the  table  and  tied  up 
with  the  sHngs,  the  halters  and  head-straps  securing  him,  and  the 
hobbles  being  in  place,  the  rope  of  the  upper  piilley  is  pulled  by 
an  assistant,  and  the  table  moved  slowly  into  the  jjroper  position. 
The  rope  being  then  fastened  to  the  ring  in  the  floor,  the  table  is 
immovable.  Upon  the  completion  of  the  operation  the  rope  is 
gradually  slackened,  while  an  assistant  pulls  on  the  rope  of  the 
base  of  the  table  which  is  thus  restored  to  the  vertical  position. 


64 


MEA^'S    OF    KESTRAINT. 


MEANS  OF  SECURING  OTHER  DOIVIESTIC  ANBIALS. 

(a)  BoviNEs. — With  these  animals  benignant  measm-es  are  of 
little  avail.  Kindness  may  in  some  possible  cases — but  they  will 
be  rarely  met  with — succeed  to  a  hmited  extent,  but  to  trust  to 
the  influence  of  the  treatment  so  often  effective  with  an  intelligent 
and  docile  equine,  such  as  the  petting  caress,  the  soothing  tone 
of  voice,  or  the  kindly  glance  of  a  human  eye,  with  even  the  placid 
and  mild-eyed  milch  kine,  wUl  be  only  an  act  of  misplaced  con- 
fidence. To  blind  them,  to  induce  dizziness  by  turning  them 
rapidly  in  a  small  cu'cle,  may  at  times  produce  good  results,  but 
even  then  these  measures  will  be  more  reliable  if  combined  with 
more  palpable  agents  of  restraint. 

Cattle  may  be  kept  quiet  in  the  standing  position  by  raising 
their  heads,  by  passing  the  index  finger  and  thumb  of  one  hand 
into  the  nostrils,  with  the  arm  over  the  face,  and  raising  the  tip 
of  the  head  upward,  while  the  other  hand,  grasping  one  of  the 
horns,  moves  the  top  of  the  head  downward,  the  resistance  of  the 
animal  being  overcome  by  pinching  the  nose  with  the  hand  which 
grasps  it  with  more  or  less  force.  By  this  means  the  head  of  the 
animal  is  fixed,  and  the  operator  guarded  against  injury  from  the 
horns,  and  the  movements  more  or  less  hmited.  While  maintain- 
ing this  position,  the  cavity  of  the  mouth  can  be  examined  and 
even  short  and  simple  operations  rapidly  performed.  Another 
device  for  preventing  the  animal  from  using  his  horns  as  a  means 


Fig.  41.— Securing  Cattle. 


SECURING    OTHER    DOMESTIC    ANIMALS. 


55 


of  contention  is  to  tie  a  long  rope  around  their  base,  passing  it 
along  the  neck  and  the  back  with  one  loop  around  the  ribs  and 
another  further  back  around  the  flanks,  and  when  reaching  the 
tail  securing  it  there  by  a  knot  at  the  base  of  that  member.  The 
head  is  thus  kept  elevated,  and  he  is  restrained  from  motion  by 
the  pain  experienced  by  the  tail  when  the  rope  is  tightened  by  his 
attempt  to  flex  it.     This  assures  his  passiveness  (Fig.  42). 

The  practice  of  shielding  the  sharp  jjoints  of  the  horns  with 
smooth,  metallic  balls  is  one  which  tends  largely  to  diminish  the 
power  of  the  animal  for  doing  harm,  by  obviating  to  a  great  ex- 
tent the  danger  from  pimctured  wounds  to  which  those  who  han- 
dle them  are  exposed.  The  best  mode,  however,  of  securing  cat- 
tle while  standing,  is  by  tying  the  head  up  to  a  post  or  a  tree,  or 
again  by  yoking  an  individual  with  his  mate  or  another  animal  of 
the  same  species.  Kicks  must  also  be  guarded  against.  Those 
by  the  fore  legs  are  avoided  by  raising  one  foot  and  tying  it  on 
the  forearm,  thus  compelling  the  animal  to  stand  on  three  legs. 
But  the  hind  legs  of  cattle  are  the  most  dangerous  from  their 
ability  to  kick  in  so  many  directions,  whether  backward,  forward 
or  outward. 

Several  methods  are  recommended  by  which  to  guard  against 
this  form  of  danger.  Among  these  may  be  mentioned  the  passing 
of  the  tail  forward  between  the  hind  legs  and  then  outward,  car- 
rying it  towards  the  stifle  of  the  leg  from  which  the  -kick  may  pro- 
ceed, and  holding  it  firmly  with  a  backward  pull ;  thus  surroimd- 


FIG.  43.— To  Prevent  Cattle  from  Kicking. 


5G 


MEAXS    or    RESTRAINT. 


ing  or  tj'mg  the  leg  with  the  tail.  Again,  to  pass  a  twitch  rotmd  the 
leg  above  the  hock,  and  to  turn  it  until  the  tendo- Achilles  pressed 
upon,  is  brought  in  contact  with  the  posterior  face  of  the  leg.  A 
loop  of  rope  twisted  upon  a  stick  will  answer  the  sarae  purpose. 
The  use  of  hobbles,  single  or  double,  or  of  the  side  lines  to  secui-e 
the  hind  legs,  has  also  been  recommended,  as  with  solipeds,  with 
the  difference  that  the  horns  furnish  a  strong  means  of  support, 
which  is  entirely  lacking  in  the  soliped.  A  method  approved  by 
some  of  controlling  the  motion  of  the  animal  is  to  pass  a  rope  on 
one  hind  leg  above  the  fetlock,  and  to  carry  this  leg  well  forward, 
or  even  to  raise  it  from  the  ground  and  to  tie  it  by  the  rope  to  the 
forearm  of  the  same  side  above  the  knee  or  around  the  horns.  The 
use  of  a  long  bar  of  wood  held  under  the  abdomen  by  two  assist- 
ants in  front  of  the  stifles  ;  keeping  the  animal  pressed  against  a 
wall  by  means  of  a  wooden  bar,  with  which  an  assistant  pushes 
firmly  against  the  stifle  of  the  side  opposite  to  that  upon  which 
the  operator  stands  ;  binding  the  animal  against  a  wall  with  a  rope 
fixed  to  a  ring  in  front  of  the  chest  and  one  behind  the  hind  quar- 
ters— all  these  are  simple  means  employed  to  keep  cattle  quiet  in 
the  standing  position. 

Some  individuals,  however,  and  especially  bulls,  are  altogether 
intractable,  and  require  more  severe  and  effectual  modes  of  pun- 
ishment. These  are  appHed  upon  the  muzzle  of  the  animal  in  his 
nasal  septum  by  nippers  or  clamps,  or  with  rings.  Nippers  are 
of  divers  forms.  One  true,  single  clamp  is  commonly  used  in 
Italy,  and  has  been  modified  in  England ;  another  is  in  use  in  Hol- 


FiG,  43.— Italian 
Noae  Clamp. 


Fig.  44.— Modifled 
English  Nose  Clamp 


Figs.  45  A  and  B.— Modifled  English. 
Nose  Clamps. 


SECUKING    OTHER    DOMESTIC    ANIMALS. 


57 


land,  "which  is  a  true  screw-clamp  ;  another,  which  is  preferred  in 
France — are  a  few  among  the  varieties  of  this  single  instrument 
for  the  ap2:)lication  of  pressure  upon  the  septum  nasi.  They  are 
generally  secured  on  the  front  of  the  face  by  ropes  or  straps. 
They  are  effectual  appliances,  and  by  their  aid  the  head  can  be 
kept  uj)  and  the  animal  controlled  without  difficulty.  Among  the 
rings  the  simplest  are  most  commonly  in  use.  They  are  made  in 
two  parts,  articulated  at  one  extremity,  and  united  at  the  other 
when  in  place  by  a  rivet  or  screw.  They  vary  much  both  in  form 
and  size.     Some  (though  still  known  as  rhiffs)  are  square  ;  others 


Fig.  46.— Square  (?)  Rings  for  Cattle, 

are  round  and  elhptical.  The  ring  of  KoUand,  the  Alsace  ring,  and 
some  of  simpler  construction  carry  an  auxiliary  ring  at  some  part, 
of  their  circumference  with  which  to  secure  them  on  the  face  of  the 
animal  by  means  of  ropes  or  straps.  These  rings  are  apphed  after 
the  perforation  of  the  nasal  septum  with  a  trocar  or  a  punch-nip- 
pers, making  an  opening  of  a  size  corresponding  to  that  of  the 
ring.     Sometimes  the  perforation  is  made  with  a  hot  ii'on,  the 


Fig.  47.— Ring  of  RoUand. 


animal  being  properly  secured  and  tied  to  a  tree,  or  placed  in  a 
yoke  with  the  head  elevated,  the  operator  making  a  quick  pimc- 
ture  through  the  cartilage,  and  introducing  the  ring  and  riveting 
it.     The  hemorrhage  soon  ceases  spontaneously. 

In  order  to  dispense  with  the  punch,  trocar,  and  the  pvmcture 
with  the  hot  iron,  rings  of  a  special  construction  have  been  in- 
vented.    These  also  consist  of  two  parts,  and  are  also  articulated, 


58 


MEANS    OF    EESTKAINT. 


Fig.  51.— Rings  with  Toints. 


SECUEING   OTHER    DOMESTIC    ANIMALS. 


59 


one  of  the  joints  having  a  sharp  point  with  which  the  ring  is 
pushed  through  the  cartilage.  A  simple  form  represented  in 
Figure  51  shows  the  point  passing  thi'ough  an  eye  at  the  other 
extremity  of  the  ring  to  be  bent  over  it  in  order  to  close  the  in- 
strument.    The  ring  used  in  some  parts  of  France  is  contrived 


Fig.  52.— French  Rings. 


somewhat  on  the  same  plan,  but  is  more  complicated.  That  of 
Rueff  is  a  kind  of  broken  circle,  which,  when  closed,  forms  a  per- 
fect ring  in  which  the  branches  are  kept  together  by  a  small  screw. 


Fig.  53.— Ring  of  Rueff. 

The  rope  which  is  attached  to  the  nasal  ring  is  not  always  suffi- 
cient to  drive  or  control  buUs,  and  conductor  sticks  armed  at  the 
end  with  iron  hooks  of  various  shapes  are  recommended.  The 
apparatus  of  Vigan  is  a  very  simple  one,  but  it  fulfils  all  require- 
ments and  suffices  for  the  restraint  of  the  most  vicious  animals. 
It  consists  of  a  wooden  pole  with  an  ii-on  prolongation  having  a 
wide  ring  by  which  to  hold  it,  and  at  a  short  distance  from  this  a 
hook  to  be  inserted  into  the  nose  ring.  Back  of  this  is  a  strap  to 
secure  around  the  horns  the  bar  over  the  top  of  the  head  as  it  passes 
between  the  horns.  At  the  other  extremity  is  an  u'on  stifle  through 
which  a  surcingle  is  passed  to  be  tied  around  the  body  of  the 
animal.  Painful,  and  still  easy  to  apply,  this  apparatus  is  not 
only  a  powerful  means  of  restraint,  but  is  sufficient  to  jorevent 
any  motion  of  the  head. 


60 


MEANS    OF   KESTEAINT. 


Fig.  55.— Vigau's  Apparatus. 


SECURING    OTHER    DOMESTIC    ANIMALS. 


61 


Fig.  56.— Steer  Placed  in  Stock. 

The  use  of  stocks  for  the  control  of  bovines  is  often  also  re- 
quired. These  are  used  principally  in  shoeing  oxen,  but  are 
available  for  some  operations  which  require  greater  passiveness 
than  can  be  obtained  by  the  applications  of  the  simpler  means 
above  described.  It  is  only  in  exceptional  cases,  and  when  an 
operation  is  likely  to  be  unusually  painful  and  prolonged,  that  the 
recumbent  position  is  required  with  bovines. 

The  casting  of  cattle  may  be  effected  with  or  without  hobbles, 
but  in  either  case  special  care  is  necessary  to  provide  a  sufficiently 
thick  bed  to  protect  the  head,  and  guard  against  the  possible 
danger  of  fracturing  the  horns.  A  long  board  placed  transversely 
across  the  neck,  with  an  assistant  seated  on  each  end,  affords  an 
excellent  means  of  controlling  his  efforts  and  struggles.  "When 
hobbles  are  used,  they  must  be  of  smaller  size  than  those  used  for 
horses,  and  should  be  placed  above  the  fetlocks. 

To  cast  bovines  without  hobbles,  either  of  two  methods,  one 
invented  by  Eueff  of  Germany,  and  another  described  by  Gwell 
and  Hertwig,  will  answer  the  purpose.  In  the  first,  the  Kueff 
raethod,  a  rope  some  thirty-six  feet  long  is  required,  in  the  middle  of 
which  a  loop  is  made  and  fixed  round  the  base  of  the  horns.  The 
two  free  ends  are  then  passed  between  the  fore  and  the  hind  legs, 
each  beiag  twisted  from  within  outwards,  around  one  of  the 
coronets,  and  brought  back  to  the  loop  at  the  base  of  the  horns, 
through  which  they  are  passed  to  assistants,  one  on  each  side, 
with  directions  to  pull  backwards.  The  feet  are  thus  brought 
close  together,  and  the  animal  seats  himself  on  his  hind  quarters. 


62  MEANS    OF    RESTRAINT. 

and  finally  stretches  himself  on  the  bed.  If  he  struggles,  the 
traction  on  the  ropes  only  expedites  the  fall.  If  he  pushes  for- 
ward, or  attempts  to  kick  or  even  only  moves  his  feet,  the  running 
of  the  rope  is  so  much  more  facilitated. 

In  the  other  mode,  a  roiDe  about  the  same  length  and  carrying 
in  one  extremity  a  loop  which  is  thrown  over  the  horns,  is  passed 
backwards  along  the  superior  border  of  the  neck,  as  far  as  about 
its  middle,  where  a  loose  loop  is  made  ;  then  carried  backwards 
at  the  side  of  the  vertebral  column,  where  another  loop  is  made,  be- 
hind the  shoulders,  and  a  third  one  around  the  abdomen,  on  a  level 
with  the  flank,  where  an  assistant  holds  it  backwards  by  the  side 
of  the  sacrum.  If  the  animal  is  to  be  thrown  on  the  left  side,  the 
rope  must  pass  on  the  right  of  the  base  of  the  tail,  and  vice  versa. 
Two  assistants  pull  on  the  rope,  while  another  holds  the  head  and 
tries  to  bring  the  animal  down.  The  traction  on  the  roj)es  tight- 
ens the  three  loops,  and  under  the  effect  of  this  force  the  animal 
is  made  to  lie  down  qiiietly.  It  facilitates  the  operation  to  lubri- 
cate the  rope  with  a  little  grease  or  soap. 

In  order  to  avoid  complications  from  lacing  the  ropes  too 
tightly  about  the  body,  it  is  always  indicated  to  subject  the  j)a- 
tient  to  a  moderate  fast  previous  to  casting  by  this  mode. 

(b)  OviNES  AND  Caprines. — Although  these  animals  are  timid 
and.  comparatively  lacking  in  strength,  they  are  at  times  caj^able 
of  struggling  violently  and  becoming  dangerous,  and  they  can- 
not be  subjected  to  surgical  treatment  without  being  cast.  This  is 
done  by  grasping  both  legs  of  one  lateral  biped,  the  right  fore  and 
hind  legs,  for  instance,  and  laying  him  over  on  the  opposite  side,  the 
left,  and  vice  versa.  If  all  the  legs  are  to  be  secured,  those  of  each 
lateral  biped  are  first  tied,  and  with  the  two  cords  a  straight  knot 
is  made,  binding  all  together. 

If  the  seat  of  operation  is  the  head,  the  animal  is  held  by  an 
assistant,  who  sits  with  the  body  of  the  animal  between  his  legs, 
with  its  back  close  to  his  own  body,  holding  the  fore  legs  with  his 
hands,  and  controlling  the  hind  quarters  between  his  legs.  In 
some  cases  when  the  operation  is  light,  the  operator  holds  the  an- 
imal himself  without  help. 

(c)  Swine. — Securing  a  good  hold  of  this  animal  is  not  always 
an  easy  task,  and  it  sometimes  requires  not  a  httle  skill  and  cun- 
ning to  do  so.  '\\Tien  seized,  two  assistants  are  necessary  to  cast 
him,  especially  if  he  is  of  large  size,  and  when  down,  either  a  muz- 


SECURING    OTHEE    DOMESTIC    ANIMAXS. 


Fig.  57.— Twitch  for  Swine. 


zle  must  be  put  on  his  snout  to  prevent  Ms  biting,  or  a  peculiar 
twitch,  placed  between  his  jaws  and  twisted  over  the  upper  one. 

If  an  examination  or  operation  is  to  be  made  about  the  mouth, 
a  wooden  gag  placed  between  the  jaws  and  held  with  cords,  will 
be  found  of  great  utility.     The  various  operations  performed  upon 


Fig.  58.— Gag  for  Swine. 

the  noses  of  swine,  to  prevent  them  from  digging  the  ground,  may 
be  considered  to  some  extent  as  means  of  restraint.  The  incision 
of  the  snout,  which  consists  in  making  several  transverse  cuts 
through  it;  the  nasal  tenotomy,  though  not  so  successful;  the 
application  of  rings  through  the  nose,  by  the  same  methods  as 


To  Prevent  Swine  from  Digging. 


64: 


MEANS   OF    BESTEAINT. 


Fig.  59a.— Another  Mode. 


those  used  in  cattle,  are  simple  means  whicli  only  need  mention,  be- 
ing more  frequently  performed  in  fact  by  raisers  and  breeders  of 
swine,  and  indeed  rather  belonging  to  their  special  domain  than 
to  that  of  the  professional  veterinarian. 


-To  Prevent  Dogs  from  Biting. 

(f?)  Dogs  and  Cats. — Dogs  can  be  prevented  from  biting  by 
muzzhng  them,  or  with  a  cord  or  band  wrapped  first  around  the 
lower  jaw,  and  then  around  both,  and  secured  over  the  neck  behind 
the  ears. 

To  examine  the  mouth  in  the  absence  of  a  speculum,  as  the 
one  represented  in  Figure  61,  the  mouth  may  be  held  open  by 
cords  passed  around  each  jaw  behind  their  tusks,  and  pulling 
them  apart.    If  the  animal  is  dangerous  or  ugly,  the  collar  nippers 


SECURING    OTHER    DOMESTIC    ANIMALS. 


65 


Fig.  63.— Collar  Nippers  for  Dogs. 

become  very  handy,  in  order  to  hold  them  by  the  neck  and  keep 
them  under  control,  whether  for  operation  or  for  administration 
of  medicines. 

Cats  are  most  difficult  to  handle.  They  bite  and  they  scratch, 
and  they  are  often  unconquerable  until  they  are  fully  subjected  to 
general  anesthesia.  In  many  instances,  the  co-operation  of  a  good 
assistant,  accustomed  to  handling  them,  may  be  found  necessary. 
They  may  sometimes  be  made  amenable  to  treatment  by  grasping 
them  by  the  neck  behind  the  ears,  and  close  to  the  head  with  one 
hand,  and  securing  the  fore  paws  with  the  other,  while  a  second 
assistant  holds  the  hind  legs,  or  it  may  become  necessary  to  have 
the  four  paws  tied  tightly  together,  and  only  the  head  held  by  the 
assistant. 

We  have  heard  of  the  utilization  of  a  man's  boot  as  a  means  of 
feline  restraint,  particularly  in  the  castration  of  the  male,  or 
"  Tom,"  the  head  and  body  of  the  animal  being  thrust  into  the  leg 


6G  MEANS    OF    RESTEAINT. 

of  the  garment,  leaving  only  the  posteiior  portions  exposed  and 
accessible  to  the  operator.  This  may  not  be  a  scientific  device, 
but  its  effectiveness  can  hardly  be  doubted. 

SUKGICAL  ANESTHESIA. 

A  resort  to  the  various  means  of  restraint,  which  we  have  been 
considering,  is  sufficient  in  a  majority  of  cases  to  bring  under 
perfect  control  such  animals  as  require  to  be  subjected  to  surgi- 
cal treatment.  But  there  is  a  class  of  cases  in  which  they  become 
inadequate  to  meet  the  great  requirements  of  inducing  in  the  pa- 
tient a  condition  in  which  a  great  diminution,  or  the  entire 
suspension,  of  sensibility  and  consciousness,  with  all  power  of 
muscular  reaction,  is  established  throughout  the  organism.  This 
result  is  obtained  through  the  characteristic  action  of  the  special 
therapeutical  compounds,  known  as  anesthesia. 

It  is  not  merely  as  a  more  effectual  means  of  securing  control 
over  refractory  patients  that  their  administration  is  justified.  It  is 
also  prompted  by  a  proper  humanitarian  feeling  in  cases  in  which 
severe  and  prolonged  suffering  accompany  the  operation. 

In  veterinary  surgery,  the  indication  for  anesthesia,  has  not,  to 
the  same  extent  as  in  human,  the  avoidance  of  pain  in  the  patient 
for  its  object,  and  though  the  duties  of  the  veterinarian  include 
that  of  avoiding  the  infliction  of  unnecessary  pain  as  much  as 
possible,  the  administration  of  anesthetic  compounds  aims  prin- 
cipally to  facilitate  the  performance  of  the  operation  for  its  own 
sake,  by  depriving  the  patient  of  the  power  of  obstructing,  and 
perhaps  even  frustrating  its  execution,  to  his  own  detriment,  by 
the  violence  of  his  struggles,  and  the  persistency  of  his  resist- 
ance. To  prevent  these,  with  their  disastrous  consequences,  is  the 
prime  motive  in  the  induction  of  the  anesthetic  state.  That  it  per- 
fectly succeeds  in  fixing  the  patient  in  the  attitude  most  favor- 
able for  the  sui'geon  in  the  execution  of  the  various  parts  of  his 
task,  needs  no  affirmation,  nor  need  we  attempt  to  measure  the 
value  of  the  discovery,  which  has  proved  itself  to  be  such  a  price- 
less benefaction  to  the  world. 

There  are  special  cases  where  anesthesia  is  more  particularly 
necessary  than  in  others,  and  where  absolute  immobility  of  the 
patient  is  essential,  and  entire  muscular  relaxation  indispensable. 
Thus  it  is  indicated  in  the  reduction  of  fractures  or  dislocations  in 


SURGICAL    ANESTHESIA.  67 

the  large  domestic  animals ;  in  cases  of  delicate  manipulation 
and  dissection  with  sharp  instruments,  as  in  the  operation  for 
strangulated  inguinal  hernia;  in  the  reduction  of  other  hernial 
tumors,  in  the  performance  of  neurotomy;  in  operations  upon 
the  eye,  and  in  the  removal  of  tumors  of  certain  kinds.  It  is  also 
indicated  in  certain  oj^erations  upon  the  foot,  which  are  always 
accompanied  with  great  pain,  such  as  that  for  the  extirpation  of  a 
portion  of  the  quarter  of  the  foot,  in  the  removal  of  the  cartilage 
affected  with  necrosis  (quittor);  or  again,  in  deep  punctured  wounds 
of  the  sole,  where  the  resection  of  the  plantar  aponeurosis  becomes 
necessary,  or  the  bones  are  scraped  with  the  knife. 

The  anesthetic  condition  is  also  very  favorable  for  the  reduc- 
tion of  displaced  organs,  as  of  a  prolapsed  rectum,  or  uterus,  or 
bladder. 

In  operations  upon  the  teeth,  in  some  cases  of  parturition, 
in  castration,  in  firing,  or  even  in  the  application  of  hobbles,  the 
induction  of  the  anesthetic  state  has  often  been  of  great  benefit 
in  quieting  nervous  animals,  and  subduing  them  to  a  condition  of 
passiveness,  which  relieved  the  movements  of  the  surgeon  frorn 
all  embarrassment  and  uncertainty. 

As  with  human  patients,  anesthetics  are  contra-indicated  in 
animals  subject  to  diseases  of  the  heart  or  of  the  lungs.  A  fuU 
stomach  is  also  always  a  contra-indication  of  their  administration, 
especially  in  solipeds,  which  are  lacking  in  the  abihty  to  reheve  it 
of  its  contents  by  vomiting. 

Anesthesia  may  be  either  local  or  general,  according  to  the 
area  of  its  efiects.  Local,  when  apphed  to  the  skin  over  a  limited 
surface,  to  which  its  efiects  are  confined ;  and  general,  when  ad- 
ministered by  inhalation,  and  through  the  respiratory  organs  in- 
fluencing the  entire  economy. 

In  local  anesthesia  the  efl'ects  are  obtained  either  by  the  pulveri- 
zation of  the  proper  substance  upon  the  region  where  it  is  required 
to  take  effect,  or  by  the  subcutaneous  injection  of  special  agents. 
General  anesthesia  is  usually  produced  by  the  inhalation  of  the 
vapors  of  ether  or  of  chloroform. 

LOCAL  ANESTHESIA. 

The  special  indications  for  this  are  so  numerous  that  they  may 
almost  be  considered  as  general,  if  not  universal,  and  its  applica- 
tion is  so  simple  and  easy  a  process,  and  its  effects  usually  so  cer- 


68 


MEANS    OF    KESTRAINT. 


tain,  that  it  ^vould  become  tlie  practitioners  of  our  day  to  utilize 
it  more  frequently  and  extensively  than  they  do.  It  is  available 
as  well  as  useful  in  the  simplest  operations,  and  may  be  employed 
in  the  opening  of  abscesses  and  cysts ;  in  the  puncture  of  cold 
abscesses  with  the  hot  irons;  in  the  puncture  of  the  cornea;  in  neu- 
rotomy ;  in  simjjle  incisions  of  the  skin ;  in  the  removal  of  small 
tumors,  etc.,  etc.  We  have  used  it  with  the  best  results  inui-eth- 
rotomy,  in  caudal  myotomy,  in  amputation  of  the  tail,  and  the 
removal  of  mammary  tumors  in  dogs,  etc.  Bouley  long  ago  rec- 
ommended its  application  to  surgical  diagnosis,  in  cases  of  doubt- 
ful lameness,  an  expedient  which  has  recently  been  introduced  into 
this  country  by  several  veterinarians,  for  the  differential  diagnosis 
of  shoulder  and  foot  lameness. 

We  have  remarked  that  the  anesthesia  can  be  produced  in 
several  ways,  though  two  are  principally  in  use.  Among  these 
properly  termed  minor  and  secondary  expedients,  are  the  apj)lica- 
tion  of  cold  water  or  ice,  and  cooling  or  freezing  mixtures,  and 
pressure  upon  the  blood-vessels  and  nerves,  which  have  for  years 
been  among  the  adjunct  and  agencies  of  surgical  practice,  but 
have  given  place  in  recent  times  to  methods  more  potent  and 
more  certain  in  their  effects.  Notwithstanding  this,  however, 
some  mention  of  theu'  nature  and  qualities,  and  the  methods  of 
utihzing  them  will  not  be  out  of  place,  if  only  as  a  matter  of  gen- 
eral reference,  and  a  case  might  arise  in  practice  when  the  infor- 
mation might  become  practically  valuable. 

1st.  Pulverization  of  an  Anesthetio  Liquid. — The  apparatus 
employed  for  this  process  is  the  invention  of  Dr.  Richardson,  and 
though  the  spraying  tube  has  been  from  time  to  time  more  or 


Fig.  64.— Richardson  Atomizer. 


LOCAL    ANESTHESIA.  69 

less  modified,  the  mode  of  its  employment  continues  unchanged  ; 
though  any  substance  susceptible  of  easy  pulverization  may  be 
employed.  Ether  is  the  agent  most  frequently  chosen.  Kigolene 
has  given  us  great  satisfaction  in  our  own  practice. 

In  impingiag  upon  the  skin  in  a  state  of  excessive  division, 
the  rapid  evaporation  of  the  liquid  lowers  the  temperature  of  the 
surface  with  which  it  comes  in  contact,  and  it  is  this  process  of 
refrigeration  which  diminishes  the  local  sensibility,  and,  as  the 
effect  increases,  overcomes  it  entirely  for  the  time  being,  or  so 
long  as  the  spray  continues  to  be  thrown  upon  the  part. 

Some  slight  objections,  however,  may  be  alleged  against  this 
mode  of  producing  insensibility,  arising  from  the  special  proper- 
ties of  the  fluid  employed,  and  for  this  reason  the  mode  by  sub- 
cutaneous injection  is  somewhat  to  be  preferred. 

2d.  Subcutaneous  Ivjections. — Both  ether  and  chloroform 
have  been  recommended,  and  extensively  used,  in  this  manner, 
but  without  doubt  the  salts  or  compounds  of  cocaine  possess  ad- 


FiG.  65.— Syringe  of  Pravaz. 

vantages  over  either  of  them.  An  epidermic  syringe,  or  that  of 
Pravaz,  is  generally  used  for  the  purpose,  with  a  solution  of  from 
four  to  twenty  per  cent,  strength,  according  to  circumstances. 

If  used  on  a  tumor  a  certain  quantity  of  the  solution,  perhaps 
twenty  drops,  is  injected  under  the  skin  at  two  or  three  points 
arovmd  its  cu'cumference,  the  desired  effect  following,  and  the 
parts  being  ready  for  the  operation  within  from  eight  to  ten 
minutes,  more  or  less,  according  to  the  strength  of  the  dose 
administered.  Either  of  these  modes  of  local  anesthesia  is  harm- 
less, and  may  be  employed  without  risk  or  fear  of  complications. 


70  MEANS    or    RESTRAINT. 

GENEEAL  ANESTHESIA. 

The  three  principal  agents  which  recommend  themselves  by 
the  efficiency  and  certainty  of  their  action  in  producing  general 
anesthesia,  are  ether,  chloroform  and  chloral  hydrate.  Theu' 
adaptation  varies,  however,  with  the  animals  subjected  to  theu' 
administration.  Chloroform  and  chloral  are  chiefly  used  for  the 
larger  animals,  principally  horses,  while  chloral  and  ether  are  re- 
served for  the  smaller  kinds,  with  which  chloroform  is  so 
generally  dangerous,  and  even  so  often  fatal,  that  its  use  with 
them  is  almost  entu"ely  discarded. 

Insensibility  by  Anesthetic  Vapors. — The  modes  adopted  for 
the  inhalation  of  the  vapors  of  chloroform  are  numerous,  but 
among  them  all  the  merit  of  simplicity  should  probably  be  award- 
ed to  that  which  is  recommended  by  Bouley.  This  consists  in 
the  introduction  into  each  nostril  of  a  small  sponge,  or  a  ball  of 
oakum,  saturated  with  the  ether  or  chloroform,  and  held  in 
place  by  the  hands  of  assistants.  The  inhalation  of  the  vapors, 
which  are  thus  mixed  with  air,  proceeds  rapidly,  the  sponges 
being  recharged  as  soon  as  they  become  exhausted,  and  returned 
to  the  nostrU,  until  the  object  in  view  is  accomplished.  But 
while  this  mode  is  a  very  convenient  one,  we  conceive  it  to  be 
liable  to  certain  objections. 

Fu'st,  unless  the  pouring  of  the  liquid  is  very  carefully  per- 
formed and  in  such  quantity  that  the  sponge  is  not  over-saturated, 
there  is  danger  that  a  large  portion  of  it  may  be  wasted,  by  run- 
ning off,  either  on  the  bed,  or  possibly,  into  the  nostrils,  causing, 
in  the  latter  case,  great  irritation  of  the  mucous  membrane. 
And  if  the  anesthesia  is  to  be  continued  for  a  considerable  length 
of  time,  the  eifect  produced  ujDon  the  delicate  membrane  of  the 
nose  may  be  sufficiently  serious  to  end  in  the  sloughing  of  the 
parts.  It  must  certainly  have  been  with  the  view  of  avoiding 
this  complication  that  Defays  invented  the  inhaler  shown  in 
figure  66  with  its  wide  range  of  aj^pHcation,  from  the  dog  to 
the  horse. 

Many  veterinarians  have  adopted  an  arrangement  consisting 
of  a  strong  leather  muzzle  with  large  openings  at  its  bottom  and 
sides  for  the  free  admission  of  the  atmospheric  air,  the  sponge 
or  oakum  chai'ged  with  the  chloroform  or  ether  being  placed  in  the 
bottom  of  the  muzzle,  which  is  fixed  upon  the  animal's  head  in  the 


GENEKAL    ANESTHESIA. 


71 


Fig.  66.— Apparatus  of  Defays. 

ordinary  way.  This  is  a  very  convenient,  though  quite  a  simple 
contrivance,  but  Enghsh  veterinarians,  and  among  them  Mr.  E. 
Cox,  recommend  in  preference  a  chloroform-bag,  in  the  form 
of  an  ordinary  bag,  made  of  strong  canvas,  both  ends  of  which  can 
be  closed  by  a  running  string,  one  being  tied  around  the  nose 


Fig.  67.— Cox's  Chloroform  Bag  in  Position. 

while  the  bag  is  secured  by  cords  to  the  halter  or  to  the  straps 
of  the  cap.  The  chloroform  is  introduced  into  the  bag  by  means 
of  a  thin  j^iece  of  cloth  saturated   with  the  liquid. 

The  chloroform  nose-cap  recommended  by  Mr.  Gresswell  also 
answers  a  very  good  purpose,  and  in  fact,  possesses  advantages 
which  render  it  superior  to  the  apparatus  of  Mr.  Cox.  It  is  not 
so  portable  in  its  form,  but  is  more  durable  ia  its  construction. 
In.  fact,  it  produces  the  features  of  the  ordinary  stable  muzzle 
which  we  have  already  mentioned. 

The  apparatus  of  Carlisle  is  also  one  of  English  invention,  for 
which  great  merit  is  claimed.  We  have  used  it,  and  the  trial  has 
shown  it  to  possess  many  features  of  marked  superiority  over  the 
others. 

The  quantity  of  liquid  required  to  bring  a  large  animal  under 
complete   general   anesthesia   cannot   be   positively   ascertained. 


72 


MEANS    OF    RESTRAINT. 


Fig    68  — Gi  esswell  8  Chloro- 
form Nose-Bag. 


Fig.  69.— Carlisle's  Chloroform  Inhaler. 


While  it  has  often  been  induced  by  the  inhalation  of  a  single 
ounce,  there  are  cases  in  which  two,  three,  or  even  more  have 
been  necessary.  An  essential  point  to  consider  is  that  the 
chloroform  should  be  absolutely  pure.  Mixtures  of  two  or  more 
drugs  have  also  been  employed,  usually  ether  and  chloroform, 
with  or  without  the  addition  of  alcohol,  but  the  result  of  all  ex- 
perimental tests  has  been,  with  us,  to  establish  the  conviction, 
that  as  yet,  chloroform  used  singly  has  proved  itself  to  be  the 
most  effective  and  the  safest  of  all.  The  administration  of 
chloroform  of  course  pre-supposes,  besides  all  the  other  conditions 
and  preliminaries  of  an  operation,  siich  as  previous  fasting,  the 
preparation  of  the  bed,  and  other  incidental  steps,  the  act  of 
throwing  the  patient. 

When  the  effects  of  the  inhalations  begin  to  become  manifest, 
the  first  physiological  change  noticed  is  an  extreme  agitation, 
accompanied  with  coughing.  The  animal  struggles  more  or  less 
violently,  the  ii-ritation  and  tickhng  of  the  thi'oat  produced  by  the 
vapors  upon  the  laryngeal  mucous  membrane,  giving  rise  to  a 
spasmodic  motion  of  the  glottis,  and  whether  the  patient  be  a 


GENERAL    ANESTHESIA.  73 

large  or  a  small  animal,  he  exerts  his  strength  to  rid  himself  of 
the  apparatus  and  regain  his  freedom  of  motion. 

These  manifestations  are,  however,  but  of  short  duration,  and 
are  soon  followed  by  a  state  of  passiveness,  the  respiration  be- 
coming easier,  the  cough  disappearing  and  his  energy  subsiding ; 
and  in  short,  he  is  subdued.  The  eye  then  assumes  its  character- 
istic expression,  its  brilliancy  is  lost,  it  is  wide  open,  the  pupils 
slowly  dilate,  the  gaze  becomes  fixed,  the  sensibility  of  the  cornea 
is  lost,  and  the  light  ceases  to  effect  it.  The  mouth  becomes 
more  or  less  loaded  with  saliva;  the  pulse,  which  must  be  carefully 
noted  by  an  assistant,  becomes  slow  and  weak,  the  respii-ation 
returns  to  its  normal  condition ;  the  state  of  complete  anesthesia 
has  been  reached,  and  the  patient,  in  happy  unconsciousness,  is 
ready  for  the  surgeon. 

The  time  required  to  reach  this  condition  varies  with  the  sub- 
ject, and  especially  with  the  quality  of  the  drug  administered.  The 
average  period  is  from  one  to  five  minutes  in  small  animals,  and 
from  ten  to  fifteen  in  the  large.  In  some  few  cases,  however,  half 
an  hour  may  elajDse  before  complete  insensibility  is  produced,  and 
again  animals  are  encountered  with  peculiar  idiosyncrasies,  which 
remain  entirely  refractory,  and  successfully  resist  every  attempt 
to  reduce  them  to  insensibility ;  a  statement  equally  true  when 
applied  to  human  patients. 

The  duration  of  the  Anesthesia. — Some  animals  remaining 
under  the  influence  only  for  a  few  minutes,  sometimes  from  fifteen 
to  thirty  or  forty,  it  becomes  necessary  to  prolong  the  insensibil- 
ity by  renewing  the  inhalation,  and  the}'  must,  therefore,  be  con- 
tinued until  the  completion  of  the  operation.  Recovery  from  the 
anesthetic  state  does  not  always  take  place  immediately  and  per- 
fectly. As  the  effect  begins  to  subside,  the  animal,  having  parti- 
ally regained  his  senses,  begins  to  move  his  eyes,  raises  his  head, 
perhaps  allows  it  to  fall  back  slowly  on  the  bed,  lying  flat  on  his 
broadside ;  then  his  legs  begin  to  move,  and  presently  he  attemj)ts 
to  spring  suddenly  to  his  feet.  He  may  succeed  in  doing  so,  but 
again,  his  muscles  may  not  have  yet  recuperated  their  power  of 
full  action,  and  there  may  be  danger  of  his  experiencing  a  heavy 
fall  on  the  bed.  His  condition  is  one  of  drunkenness,  and  he  re- 
quires to  be  watched,  and,  if  necessary,  aided,  in  order  to  prevent 
him  from  injuring  himself  by  efforts  beyond  his  strength  while 
in  a  state  of  weakness  of  which  he  is  unaware. 


74  MEANS    or    KESTKAINT. 

The  symptoms  of  general  anesthesia  by  chloroform,  which  we 
have  detailed,  are  those  of  ordinary  cases.  There  are,  however, 
other  symptoms  which  the  vigilant  operator  will  not  fail  to  look 
for,  which  are  of  great  importance  as  indicative  of  the  dangers, 
and  premonitory  of  some  of  the  casualties  incident  to  the  situ- 
ation.    These  we  reserve  for  subsequent  consideration. 

Anesthesia  hy,  the  Administration  of  Chloral.  —  While  this 
drug  and  its  compounds,  as  sometimes  used,  produces  in  some 
cases  a  condition  of  insensibility  quite  as  complete  as  that  ob- 
tained by  chloroform  or  ether,  yet  there  are  cases  in  which  only  a 
less  complete  degree  of  success  can  be  secured,  though  still  suffi- 
cient to  be  of  great  assistance  to  the  surgeon  as  well  as  of  rehef 
to  the  patient.  That  the  intra- venous  injection  of  chloral  has  been 
shown  to  be  the  best  of  all  modes  of  obtaining  anesthesia,  is  an 
admitted  truth,  but  unfortunately  it  is  a  method  of  introducing  it 
into  the  system  which  will  scarcely  ever  become  sufficiently  prac- 
ticable to  be  available  outside  of  the  laboratory.  Efforts  to  over- 
come the  difficulty  referred  to  have  not  been  wanting,  however^ 
and  Messrs.  Cadeac  and  Mallet  have  experimented  with  chloral  by 
combining  its  action  with  that  of  muriate  of  morphine.  By  first 
injecting  subcutaneously  a  certain  quantity  of  a  solution  of  mor- 
phine, and  following  it  after  a  few  minutes  by  a  rectal  injection 
of  a  solution  of  chloral,  they  have  obtained  complete  anesthesia 
in  a  very  short  time.  For  a  horse  they  have  used  eighty  centi- 
grammes to  one  gramme  of  the  morphine,  and  from  eighty  to  one 
himdred  grammes  of  chloral;  and,  for  a  dog,  ten  centigrammes  of 
morphine  and  twenty  grammes  of  chloral 

The  administration  of  chloral  in  the  form  of  balls,  as  commonly 
practised  by  many  veterinarians,  in  doses  varying  from  one  to  one 
and  a  half  ounces,  given  on  an  empty  stomach,  and  from  one  to  two 
hours  before  the  operation,  is  undoubtedly  good  practice.  We 
have  not  personally  had  the  opportunity  of  testing  it  in  cases  of 
long  and  tedious  dissections,  but  the  benefit  we  have  often  de- 
rived from  it  in  short,  though  painful  operations,  justifies  us  in 
recommending  it,  not  only  for  this  very  object,  but  in  any  case, 
where,  from  any  possible  cause,  an  animal  is  likely  to  receive  severe 
injuries  during  his  struggles  to  liberate  himself. 


ACCIDENTS    OF    GENERAL    ANESTHESIA.  75 

ACCIDENTS  OF  GENERAL  ANESTHESIA. 

Notwithstanding  the  caution  observed  in  the  use  of  ether  or 
chloroform,  and  however  pure  these  articles  may  be,  accidents  must 
be  expected  during  their  administration.  They  are  not  always  of 
a  serious  nature,  but  they  may  at  times  have  fatal  results. 
Among  those  of  minor  importance  is  the  cough  which  becomes 
at  times  quite  troublesome,  but  may  be  readily  subdued  by  a  tem- 
porary arrest  of  the  inhalation ;  vomiting,  which  often  occiu's  in 
small  animals,  but  which  can  be  guarded  against  by  causing  the 
patient  to  fast  long  enough  to  insure  an  empty  stomach  before 
being  etherized,  and  spasmodic  contractions,  of  which  the  exis- 
tence, when  undoubtedly  present,  is  often  overlooked.  Among 
those  of  more  serious  nature  are  syncope,  either  cardiac  or  res- 
piratory. 

Cardiac  syncope  is  a  very  serious  accident,  and  in  a  majority 
of  cases  proves  fatal,  especially  in  large  animals.  It  is  sudden  in 
its  manifestation,  and  often  unobserved  until  at  too  late  a  period 
of  the  operation.  It  is  due  to  a  gradual  diminution,  followed  by 
an  arrest  of  the  muscular  contractions  of  the  heart,  and  as  far  as 
our  observation  extends  is  always  associated  with  pre-existing 
heart  disease.  The  apphcation  of  cold  douches,  of  heart  stimu- 
lants, ammonia  given  by  inhalation  or  internally,  are  the  first  in- 
dications in  these  cases. 

Respiratory  syncope,  which  is  far  less  dangerous,  arises  from 
the  influence  of  the  laryngeal  nerves  upon  the  activity  of  the  res- 
piratory centers.  Its  access  is  sudden,  being  caused  by  the  arrest 
of  the  respiration.  There  is  no,  convulsion,  though  the  intoxica- 
tion produced  by  the  anesthetic  vajDors  is  sudden  in  its  effects,  and 
is  generally  detected  only  by  careful  watching. 

The  apphcation  of  electricity,  that  of  the  electro-puncture,  and 
especially  persevering  eiforts  to  effect  artificial  respiration,  may 
sometimes  save  the  animal,  provided  the  trouble  is  not  connected 
with  the  complete  arrest  of  the  contractions  of  the  heart. 

In  view  of  these  possible  incidental  conditions,  some  general 
rules  suggest  themselves  tending  to  their  avoidance.  Great  care 
and  exactness  in  gauging  the  doses  of  the  anesthesia,  with  such 
caution  in  their  administration  as  to  j)roduce  a  slow  and  gradu- 
ated eifect,  is  one  point.  Free  allowance  for  the  introduction  of 
air  with  the  vapors  inhaled ;  close  attention  to  the  state  of  the 


76  MEANS    OF    RESTKAINT, 

circulatory  and  respiratory  apparatuses,  and  the  manner  in  which 
their  functions  are  executed,  by  noticing  the  heart-beat  and  watch- 
ing the  pulse  and  the  movements  of  respiration  at  the  flanks,  are 
other  points  of  importance. 

Another  point  is  the  need  of  bearing  in  mind  that  an  animal 
submitted  several  days  in  succession  to  general  anesthesia  be- 
comes more  and  more  susceptible  to  its  effects,  and  therefore 
more  exposed  to  the  dangers  they  imply. 

ACCIDENTS  INCIDENTAL  TO  THE  USE  OF  ]MEANS 
OF  RESTRAINT. 

"We  have  already  considered  some  of  the  accidents  which  are 
likely  to  interfere  with  the  successful  apj)lication  of  the  means  of 
restraint,  and  especially  with  reference  to  the  final  act  of  the  pre- 
liminary series  which  occur  at  the  moment  of  throwing  the  animal 
and  depositing  him  on  his  bed,  particularly  such  as  may  follow 
the  neglect  of  properly  protecting  the  head  with  the  cap  or 
blinkers,  or  by  an  unnecessarily  prolonged  use  of  the  twitch,  or 
from  the  sudden  and  violent  movements  of  the  animal  himself. 
These  can  usually  be  obviated  by  projper  forethought  and  watch- 
fulness. But  the  most  careful  attention  cannot  always  assure 
immunity  from  miscarriage  and  casualties.  Thus,  a  common  mis- 
hap, and  one  which  cannot  be  anticipated  nor  prevented,  is  the 
sudden  and  heavy  fall  of  the  animal  just  as  his  equilibrium  is  lost. 
The  lesions  which  may  follow  this  casualty  may  have  their  seat 
either  in  the  hard  or  soft  structures,  and  are  of  the  most  serious 
character,  not  only  including,  at  times,  fractures  and  dislocations, 
and  lacerations  of  the  soft  tissues,  including  the  muscles,  but  may 
affect  the  viscera,  and  even  the  blood  vessels  and  the  nerves — in 
this  last  case  involving  the  parts  in  all  the  evils  of  local  paralysis 
and  its  disabilities. 

(a)  Feactukes. 

This  form  of  injury  may  have  its  seat  in  the  vertebral  column, 
the  ribs,  and  the  bones  of  the  extremities. 

1st.  Fractures  of  the  Vertebral  Column. — In  the  list  of  frac- 
tures, those  of  this  region  of  the  body  are  the  most  frequent. 
The  numerous  reports  of  cases  which  are  made  public  by  veterin- 
ary wiiters  f ui-nish  sufficient  evidence  of  the  f acihty  and  frequency 
of  theii-  occurrence,  even  when  the  most  careful  attention  has  been 


ACCIDENTS    DUE    TO    KESTRAINT.  77 

bestowed  on  all  the  details  of  the  work  of  casting.  The  very 
peculiar  ch-cumstances  under  which  these  spinal  fractures  some- 
times take  place,  baiiiing  calculation,  and  occurring  when  least 
expected  or  prepared  for,  illustrate  the  responsibihty  which  the 
veterinarian  assumes,  and  the  culpability  with  which  he  would 
become  chargeable  b}'  undertaking  the  work  without  due  caution 
and  preparation,  or  without  notifying  the  owner  of  the  animal  of 
all  the  hazards  and  difficulties  attending  the  case  in  all  its  steps 
and  stages.  As  will  be  seen  when  we  come  to  the  consideration 
of  this  special  lesion  in  the  chaj)ter  on  fractures,  the  symptoms 
which  accompany  this  accident  are  distingmshed,  as  to  one  feat- 
ure, by  the  suddenness  of  their  appearance,  which  takes  place  at 
the  moment  of  the  infliction  of  the  injury  or  immediately  after. 
But  the  most  important  of  the  characteristics  of  the  case  is  the 
grave  fact  that  the  fracture  is  almost  always  of  the  comminuted 
kind.  This  is  held  to  be  due  to  the  excessively  powerful  mus- 
cular contraction,  resulting  in  the  over-arching  of  the  vertebral 
column  simultaneously  with  pressure  from  the  abdominal  organs, 
caused  by  the  sudden  extension  of  the  anterior  and  posterior  . 
bipeds,  bound  together  with  hobbles,  the  violence  of  the  struggle 
so  powerfully  pressing  the  vertebrae  together  as  to  result  in  the 
yielding  of  theu^  spongy  structui'e;  and  the  crushing  or  grinding 
of  the  bone  is  the  consequence. 

This  theory  of  the  production  of  fractures  of  this  character 
has  been  adopted  by  the  majority  of  European  veterinarians,  es- 
pecially by  those  of  France,  where  it  is  understood  as  "Bouley's 
Classical  Theory."  In  1889,  however,  another  theory  was  pro- 
pounded and  defended  by  Mr.  Moussel,  of  Alfort,  differing  en- 
tirely from  that  of  Bouley,  in  which  he  claims  that  the  kind  of 
fracture  in  question  is  not  caused  by  an  over  Jiexion  of  the  spine, 
but,  on  the  contrary,  is  the  effect  of  an  excessive  extension!  result- 
ing from  greater  contraction  of  the  ilio-spinahs  muscle. 

According  to  Dickerhoft,  "  three  factors  are  active  in  the  cau- 
sation of  these  fractures.  In  the  first  place,  the  animal  must  have 
some  object  as  di, point  (V  appui  for  one  hind  leg;  that  point  must 
be  connected  with  either  one  of  the  other  extremities  or  directly 
with  the  trunk.  *  *  *  Secondly,  the  horse  must  make  his  vertebral 
column  teuse  by  the  contraction  of  the  spinal  extensor  muscles. 
*  *  *  Thirdly,  the  horse  must,  simultaneously  with  the  extension 
of  the  hind  leg  and  that  of  the  vertebral  column,  draw  its  pelvis 


78  MEANS    OF    RESTRAINT. 

to  one  side.  *  *  *  But  no  one  of  these  three  elements,  in  itself, 
will  produce  a  fracture;  they  must  all  concui'." 

Whatever  may  be  the  value  of  these  theories,  the  fact  that  at 
post-mortem  examinations  fractures  have  been  discovered,  in  some 
cases  in  the  annular  portion,  and  in  others  in  the  body,  seems  to 
prove  that  any  one  of  them  is  equally  apphcable  with  another. 

To  prevent  these  fractures,  therefore,  becomes  the  principal 
object  of  the  surgeon  at  the  critical  moment  when  the  animal  is 
thrown.  This  involves  a  strict  attention  to  the  rules  which  we 
have  laid  down  for  his  guidance  in  the  various  stejDS  of  the  act  of 
casting;  and,  moreover,  to  have  recourse,  as  often  as  jDossible  and 
as  the  indications  suggest,  to  the  aid  of  anesthetic  agencies,  and 
by  no  means  to  ignore  the  value  or  neglect  the  use  of  the  appa- 
ratus of  Bernardot  &  Buttel. 

2d.  Fractures  of  the  liibs. — These  fractures  are  undoubtedly 
frequent,  as  the  result  of  heavy  falls  upon  a  badlj'-made  bed — too 
hard  or  too  thin,  or  perhaps  concealing  hard  substances,  as  stones 
or  the  like. 

3d.  Fractures  of  the  Pelvic  Bones. — There  are  but  few  cases 
on  record  of  this  kind  of  injury,  but  they  are  possible,  as  the  re- 
sult of  carelessness  in  the  preparation  of  the  bed  or  improper 
casting,  or  powerful  muscular  contraction. 

4th.  Fractures  of  the  Bones  of  the  Extremities. — Though  prob- 
ably less  common  than  those  last  referred  to,  these  lesions  are  not 
unknown  in  veterinary  practice.  They  occur  principally  in  the 
diaphyses  of  bones,  or  near  to,  or  at  the  epiphysis,  and  are  often  in- 
complete in  their  nature.  Delafond  describes  a  case  of  fracture 
of  the  femur  taking  place  during  the  application  of  the  clamjDS 
while  undergoing  the  operation  of  castration ;  and  another  case  is 
recorded  of  which  the  trochanter  of  the  femur  was  the  seat.  Key 
has  reported  a  case  of  fracture  of  the  cubitus  taking  place  as  the 
animal,  when  freed  from  the  hobbles,  made  a  violent  effort  to  spring 
from  the  bed  upon  which  he  had  been  thrown  to  be  fired  for  a 
chronic  enlargement.  These  fractures  of  the  extremities  may  be 
avoided  by  careful  attention,  not  only  at  the  time  of  throwing  the 
patient,  but  in  placing  him  in  position  and  in  properly  securing 
him,  and  giving  him  judicious  assistance  in  regaining  his  feet. 

5th.  Dislocations.  —  These  accidents  are  of  very  rare  occur- 
rence. One  case,  however,  is  recorded  of  a  dislocation  backwards 
of  the  humerus,  compHcated  with  fracture  of  the  cubitus. 


INJURIES    TO    SOFT    TISSUES.  79 

(b)  Injuries  to  Soft  Tissues. 

1st.  Lacerations  of  Muscles  and  their  Annexes. — These  are 
the  result  of  the  distorted  positions  into  which  the  extremities  are 
forced  while  undergoing  operations.  They  may  be  discovered 
immediately,  or  may  be  developed  a  few  days  after  the  operation. 
Inflammation  of  the  olecranean  and  pectoral  muscles,  of  those  of 
the  croup,  and  of  the  anterior  part  of  the  shoulder  have  been  re- 
ported. Bouley  has  seen  a  ruj)ture  of  the  aponeurosis  of  the  great 
and  of  the  small  oblique  muscle  of  the  abdomen,  and  one  rupture 
of  the  flexor  metatarsi.  A  case  of  laceration  of  the  diaphragm  is 
recorded  by  Bouley,  Jr.  In  one  of  our  own  patients,  laceration  of 
the  olecranean  muscles  was  followed  by  such  severe  complications, 
that  it  became  necessary  to  destroy  the  patient. 

2d.  Ruptures  of  the  Viscera. — These  are  of  rare  occurrence, 
being  generally  prevented  by  the  precaution  of  refraining  from 
throwing  the  animal,  until  assured  of  an  empty  digestive  canal  by 
previous  fasting.  Accidents,  however,  have  been  witnessed  by 
Gohier,  who  has  noticed  their  occurrence  upon  the  rectum  near 
the  anus.  This  horse  had  drunk  freely  of  water  before  being 
cast.  Bouley,  Jr.,  has  seen  a  case  of  rupture  of  the  diaphragm. 
Eey  has  known  one  of  the  heart,  Schaak  one  of  laceration  of  the 
humeral  artery,  and  even  the  giving  way  of  the  vena  cava,  in  a  case 
of  a  nervous  animal  upon  which  means  of  restraint  were  being 
applied  to  dress  a  small  wound.  The  patient  suddenly  fell,  and, 
struggling  violently,  died ;  and  at  the  post-mortem  the  abdomen 
was  found  full  of  blood,  and  the  vein  torn  back  of  the  kidneys. 

3d.  Injuries  to  Nerves. — These  are  accompanied  with  loss  of 
power,  usually  temporary,  but  sometimes  permanent.  The  posi- 
tion in  which  it  is  sometimes  necessary  to  fix  an  animal,  as  in  the 
diagonal,  is  that  in  which  they  are  most  likely  to  occur.  The 
symptoms  of  paralysis  which  are  then  manifested,  betray  them- 
selves when  the  animal  has  just  risen  from  the  bed,  when,  upon 
being  called  upon  to  move,  the  leg  is  discovered  to  be  unable  to 
carry  its  weight,  flexing  upon  its  various  bony  levers,  and  render- 
ing locomotion  impossible.  Sometimes  these  symj^toms  are  of 
but  short  continuance,  and  disappear  under  the  influence  of  strong 
stimulating  frictions.  The  leg  was,  according  to  the  popular 
phrase,  "■asleep,'"  because  of  a  temporary  arrest  and  sluggishness 
of  the  circulation.     But  in  other  cases,  the  condition  is  brought 


80  JIEANS    OF    EESTKAINT. 

on  by  a  true  lesion  of  the  nerves,  the  brachial,  the  lumbar  plexus, 
or  some  of  their  branches  having  undergone  some  traumatic  hurt 
which  may  prove  more  or  less  refractory  to  treatment. 

4th.  ^Isphi/xla. — According  to  Peuch  and  Toussaint,  this  ac- 
cident may  result  from  the  ignorance  of  assistants,  who,  in  con- 
trolling the  animal  and  keeping  him  down  on  the  bed,  have  com- 
pressed the  nostrils  too  tightly ;  or  again  it  may  be  caused  by  the 
excessive  pressure  .of  the  throat  straj^s  of  the  halter,  or  of  the  rope 
which  encircles  the  neck  when  a  horse  is  placed  in  position  for 
castration.  To  explain  the  causes  of  this  accident  should  be,  with 
an  intelligent  operator,  sufficiently  to  hint  the  means  of  prevent- 
ing its  occurrence. 

Conclusions. — A  review  of  the  matters  we  have  been  considering 
in  this  chapter  may  not  be  out  of  place,  nor  unprofitable,  even  at 
the  risk  of  being,  perhajDS,  a  little  repetitious.  In  view  of  the  oc- 
currence of  these  accidents,  and  aj)]Dreciating  the  responsibility 
assumed  by  the  surgeon  when  about  performing  an  operation 
upon  a  more  or  less  valuable  animal,  he  cannot  but  be  conscious 
of  the  obligations  which  impose  themselves  upon  him  to  take  every 
precaution  to  avoid  them.  He  should  therefore  guard  against 
their  eventual  contingency,  by  closely  inquiring  concerning  the 
condition  of  his  patient,  and  by  satisfying  himself  that  every  part 
of  the  ajDparatus  of  restraint  is  in  good  order ;  should  avoid  rough 
treatment  and  employ  anesthesia  when  possible,  and  never  put  an 
animal  in  a  constrained  position  for  treatment  when  an  operation 
can  be  otherwise  performed  more  advantageously  and  easily  and 
comfortably  to  his  patient,  and  he  should  never  allow  him  to  re- 
main in  his  restrained  and  compulsory  recumbent  position  longer 
than  is  strictly  necessary.  And  above  all,  he  should  never  under- 
take an  operation  without  having  fully  acquainted  the  owner  of 
the  animal  of  the  possibility  of  accidents.  The  fact  of  thus  ex- 
plainiag  matters  to  an  owner,  and  of  obtaining  his  intelligent  con- 
sent does  not,  of  course,  relieve  the  siu'geon  of  his  responsibility, 
but  rather,  on  the  contrary,  confirms  and  increases  it  by  thus  add- 
ing a  new,  though  an  implied  pledge  to  his  employer  to  devote 
his  most  conscientious  endeavors  and  exercise  his  best  skill  in  the 
matter,  in  token  of  his  appreciation  of  the  confidence  placed  in  his 
skill  and  faithfulness. 


CHAPTEK  II. 
SURGICAL  DIAGNOSIS. 

The  first  query  to  be  settled  in  examining  a  diseased  animal  is 
whether  the  ailment  with  which  he  is  attacked  is  merely  a  case  of 
disordered  function,  requiring  only  the  administration  of  the 
proper  drugs  to  restore  the  usual  order  of  things,  or  a  case  de- 
manding the  operative  skill  and  expert  ministrations  of  the  sur- 
geon, with  bistoury  and  cautery  and  sutiu'e.  The  decision  of  this 
query  involves  a  thorough  knowledge  of  anatomy,  and  is  compara- 
tively more  difficult,  as  well  as  more  imi^ortant,  than  the  mere 
medical  diagnosis  of  diseases  pertaining  to  internal  pathology. 
Errors  in  surgical  diagnosis  are  always  both  more  dangerous  and 
more  important  than  those  of  a  mere  medical  character,  inasmuch 
as  they  are  likely  to  be  more  readily  exposed,  and  to  involve  a 
greater  amount  of  responsibihty  on  the  part  of  the  surgeon. 

To  insure  the  certainty  of  his  diagnosis,  the  surgeon  must  caU 
into  exercise  all  his  resources  of  knowledge  and  experience,  and 
employ  all  his  faculties  of  observation  and  discrimination,  with 
such  instrumental  aid  as  may  serve  to  facihtate  and  confirm  his 
conclusion,  as  to  the  nature  of  the  cases  before  him.  He  must 
especially  employ  all  his  organs  of  sense  in  the  investigation.  A 
single  sense  is  sometimes  sufiicient  to  diagnosticate  the  character 
of  some  special  lesions,  but  more  commonly  each  sense  is  an 
auxiliary  of  the  others,  and  all  are  comj)lementary  to  each.  In 
fact,  the  surgeon  is  not  justified  in  reaching  a  conclusion  as  to  the 
detection  of  an  affection,  which  is  discovered  by  the  sight, 
or  touch,  or  smell,  or  hearing,  alone,  but  to  escaj^e  the  possibiUty 
of  error,  he  is  bound  to  confirm  his  discovery  by  the  corroboration 
of  another,  or  what  is  still  better,  of  all  the  others,  if  possible. 
In  these  cases,  as  in  others,  the  eye  is  the  most  valuable  and 
comprehensible  of  the  organs. 

1st.  Sight. — Visible  changes  of  contour,  or  color,  or  other 
deviations  from  the  usual  appearance  of  tissues,  or  of  regions,  are 
of  coiirse  first  made  known  through  the  sight  of  the  eye.  De- 
formities,  unless   of   very   minute    dimensions,  with    abnormal 


82 


SURGICAL    DIAGNOSIS. 


growths,  prominent  swellings  and  changes  of  direction  in  the 
bony  levers,  belong  to  the  same  category,  and  if  these  are  not  suf- 
ficiently distinct  or  conspicuous,  and  seem  likely  to  escape  the 
visual  observation  of  the  surgeon,  a  careful  measurement  may  de- 
cide the  point.  The  eye  must  also  discern  the  changes  occurring 
in  the  various  visible  membranes,  as  for  example,  the  heightened 
redness  of  a  congested  membrane,  and  the  paleness  of  an  anaemic 
subject. 

Again,  if  there  is  abnormal  motion  in  a  part,  as  in  fractures 
and  dislocations,  it  is  to  the  eye  that  the  disclosure  is  first  made. 
This  application  and  study  of  the  use  of  his  eye  will  be  very 
serviceable  to  the  surgeon  in  the  examination  of  the  external  sur- 
face of  the  body,  but  when  examinations  ^fvithin  the  organism,  or 
within  its  cavity,  become  necessary,  however  strong  a  hght  he 
may  have  at  his  disposal,  he  will  be  compelled  to  have  recourse 
for  assistance  to  the  speculum,  to  hold  the  parts  open. 
There  are  many  forms  of  this  instrument. 

The  speculum  oris,  for  the  mouth,  has  very  numerous  shapes, 
some  of  them  very  simple,  as  in  Figures  70  and  71,  and  some  com- 


FlGS.  70  &  71.— Simple  Speculum  Oris. 


Fig.  72.— Brogniez  Speculum  Oris. 


phcated,  as  in  Tig.  72,  the  speculum  of  Brogniez.  Green's  spec- 
ulum is  an  American  invention,  simple,  safe,  comfortable  to  the 
patient,  and  of  easy  manij)ulation  (Fig.  73).  Grange's  mouth 
speculum  is  rather  clumsy  and  heavj'  (Fig.  74).  These  instruments 
are  generally  employed  for  solipeds.  Placed  between  the  jaws, 
they  open  the  mouth  forcibly,  and  keep  it  so  as  long  as  they  con- 
tiaue  in  place. 

Sometimes,  however,  the  mouths  of  these  animals,  as  well  as 
those  of  ruminants,  can  be  held  open  without  them,  by  putting 


83 


Fig.  74. — Grange's  Speculum. 

the  tongue  out  of  one  side  of  the  mouth  with  one  hand,  while  the 
cheek  is  pulled  out  in  the  opposite  direction  with  the  other. 
This  same  manipulation  may  answer  for  large  ruminants,  provid- 
ing the  head  is  kept  elevated  by  an  assistant.  In  swine,  a  gag 
(See  fig.  58)  made  of  wood,  is  often  used,  and  the  speculum  rep- 
resented in  figure  61  answers  well  for  dogs.  At  other  times, 
however,  with  these  animals,  the  mouth  is  kept  open  by  separat- 
ing the  jaws  with  tapes  passed  around  each,  and  pvdled  apart. 


84 


SURGICAL    DIAGNOSIS. 


Fig.  75.— Reynara  Mouth  Kefleotor. 

Keynal  is  tlie  author  of  an  instrument  whicli  facilitates  the 
examination  by  the  eye  of  some  parts  of  the  mouth.  It  is 
poHshed  on  both  surfaces,  and  acts  as  a  reflector,  and,  when  in- 
troduced on  the  inside  of  the  cheek,  will  helj)  to  detect  diseased 
spots  on  the  teeth,  which  would  otherwise  escape  discovery.     The 


l''i<^.  76.— Nose  Speculum. 

speculum  to  dilate  the  nostrils  and  examine  the  nasal  cavities, 
also  acts  as  a  reflector,  but  fails,  we  think,  to  fulfill  the  object, 
for  lack  of  sufficient  dimensions.  It  is  made  somewhat  on  the 
principal  of  the  vaginal  speculum  used  in  human  medicine,  and 
acts  in  the  same  manner. 


FlO.  77.— Eye  Speculums 


SIGHT. 


85 


Fig.  78.— Ophthalmoscope. 

The  speculum  to  keep  the  eyelids  apart  will  be  found  of  great 
assistance  in  the  examination  of  that  organ,  so  sensitive  to  the 
light  when  in  a  state  of  disease,  and  so  constantly  kept  closed  on 
that  account.  It  is,  in  fact,  this  speculum  which  renders  the  use 
of  the  ophthalmoscope  practicable  for  the  examination  of  the  in- 
ternal structures  of  the  ocular  globe. 

Some  of  the  various  patterns  of  the  speculum  used  in  human 


-Examination  of  Dog's  Ear. 


86 


SURGICAL    DIAGNOSIS. 


surgery  for  the  ear,  will  be  found  available  in  the  examination  of 
the  external  auditory  canal,  especially  in  dogs.     The  dilatation  of 
the  vagina  and  the   anus  is  scarcely  ever  needed  in  veterinary 
surgery,  and  instruments  are  there- 
fore not  required;  nor  is  the  endo- 
scope, so  useful  in  human  sur- 


FiG.  60.— Vaginal  Speculum. 

gery,  of  any  value  in  veterinary  practice  from 
the  impossibility  of  using  it  upon  animals. 

To  realize  the  value  of  these  optical  aids 
in  the  examination  of  cavities,  a  strong  light 
is  indispensable.      Sometimes  the  ordinary 

solar  rays  will  be  sufficient,  but  at  others  reflected  and  concen- 
trated artificial  light  will  be  necessary,  as  in  the  use  of-  the  oph- 
thalmoscope to  examine  the  eye,  or  to  detect  the  conditions  of  the 
deep  posterior  parts  of  the  nasal  cavities. 

(b.)  Touch. — The  taxis  is  the  surgical  seuse  par  excellence, 
and  is  probably  the  more  valuable  and  rehable  of  all  the  means  of 
investigation  possessed  by  the  surgeon,  the  sight  itself  not  ex- 
cepted. Nothing  else  so  accurately  detects  the  changes  in  the 
proportions,  in  the  consistency,  in  the  elasticity,  or  even  in  the 
nature  of  tissues,  and  its  discoveries  may  be  made  serviceable  at 
every  stage  of  an  operation  of  importance  and  delicacy.  But  to 
attain  a  reliable  certainty  in  the  exercise  of  this  tactical  skill,  the 
finger  ends  must,  equally  with  the  eye,  be  thoroughly  educated  to 
perform  their  functions  with  accuracy  and  discrimination.  A 
change  in  the  aspect,  form  and  contour  of  a  region  which 
easily  escapes  detection  by  an  ordinary  observer,  will  become 
instantly  evident  to  the  well-drilled  digital  extremities  of  the  ex- 
perienced operator. 

The  object  requiring  examination  is  not  always,  however, 
within  reach  of  any  ])ortion  of  the  hand,  and  resort  must  be  had 
to  instrumental  aid  in  the  exploration  of  parts  deeply  situated,  or 
of  fistulous  tracts,  and  for  this  purpose  the  prohe  is  brought  into 
requisition.  It  is  usually  of  metallic  material,  generally  silver,  or 
of  lead,  or  may  be  made  of  gutta  percha  or  whalebone,  or  other 


87 


Fig.  81.— Straight,  curved  Directory— Silver  Probe. 


suitable,  flexible  substance,  and  either  straight  or  curved  as  the  S 
probe.  The  director  is  also  a  probe,  heavier  than  the  ordinary 
kind,  and  having  a  small  groove  running  its  length  on  one  side. 
It  is  used  as  a  kind  of  guide  to  prevent  the  deviation  of  the  bis- 
toury from  its  proper  course,  and  to  conduct  it  to  the  bottom  of  a 
wound. 

Exploring  needles  are  used  with  advantage  in  the  detection  of 
the  natiire  of  abnormal  growths,  the  small  and  narrow  wound 
which  they  make  being  sufficient  to  ascertain  the  nature  of  the 
liquid  which  may  be  present,  without  danger  of  complications. 

The  Dieulafoy  aspirator  affords  another  means  of  exploration 
and  discovery  of  deep-seated  parts,  inaccessible  in  the  ordinary 
way. 


Fig.  82.— Dieulafoy'8  Aspirator. 


88  SURGICAL    DIAGNOSIS. 

(c)  Hearing. — The  indications  obtaiaed  through  the  media 
of  the  sight  and  the  touch  may  be  usefully  supplemented,  and  are 
often  completed  by  those  which  address  the  sense  of  hearing- 
The  gurgling  sound  in  Hquid  or  gaseous  tumors,  the  peculiar 
bruit  in  aneurisms,  caused  by  the  current  of  the  blood;  the  con- 
tact of  a  stone  in  the  bladder  when  touched  by  the  exploring 
catheter;  the  peculiar  glou-gloxt  of  the  entrance  of  air  into  a  vein; 
the  characteristic  crepitation  of  fractures,  and  the  whistling  of  a 
roaring  horse — these,  and  other  signs,  convey  their  information 
with  unmistakable  distinctness  to  the  auricular  sense. 

{d)  Smell. — The  exercise  of  the  olfactory  sense  in  the  formation 
of  a  surgical  diagnosis  is  more  limited  than  those  just  con- 
sidered, and  yet  there  are  conditions  in  which  it  may  be  of  great 
importance. 

The  odor,  sul  generis,  of  gangrene  and  of  necrosis  are 
promptly  detected,  and  at  once  recognized,  and  the  existence  of 
other  pathological  conditions,  as  of  urinary  or  stercoral  fistulous 
tracts,  and  certain  afi'ections  of  the  feet,  are  betrayed  by  the 
pungent  and  aggressive  appeal  to  the  olfactory  organs. 

(e)  Taste. — As  free  from  anything  Uke  fastidiousness  in 
respect  to  offensive  contacts  and  surroundings,  as  the  sm-geon 
must  unavoidably  become,  he  draws  a  line  ;  he  insists  upon  a 
strict  monopoly  of  his  gustatory  sense  for  his  own  internal  uses, 
and  only  investigates  the  domestic  animals  in  an  ahmentary  way, 
when  entirely  healthy  individuals  are  reduced  to  2i,  post-mortem 
condition  by  the  butcher,  and  served  in  the  form  of  beef,  mutton 
and  pork,  properly  cooked.  But  if  the  surgeon  should  desire 
much  valuable  aid  from  the  exercise  of  the  physical  senses  in  form- 
ing his  diagnosis,  he  will  commit  a  serious  error  if  he  allows 
himself  to  be  entirely  and  exclusively  guided  by  them.  Strictly 
speaking,  a  direct  diagnosis  may  sometimes  be  arrived  at  by  a  care- 
ful collation  of  the  results  of  his  researches,  but  he  will  often, 
also,  be  obhged  to  modify  or  go  beyond  these  conclusions,  and 
make  an  indirect  diagnosis  besides. 

There  are  two  ways  of  making  a  positive  surgical  diagnosis 
one  which  may  be  called  the  du-ect,  or  diagnosis  by  confirmatioii 
another  known  as  indu'ect,  or  by  exclusion.     The  former  is  by 
ulterior  investigations,  confirming  a  previous  diagnosis  made  upon 
the  basis  of  a  single  and  prominent  symptom ;  the  latter  by  the 
elimination  of  aU  diseases,  which,  though  they  may  have  some 


TASTE.  89 

resemblance  to  that  wliich  has  been  suspected,  yet  are  excluded 
by  the  presence  of  some  specific  and  incompatible  symptoms. 
It  is  only  by  careful  induction  and  cautious  reasoning,  that 
the  surgeon  can  settle  the  question  of  his  diagnosis,  and  insure 
such  a  true  and  tangible  conclusion,  as  can  only  be  reached  when 
there  is  a  perfect  correspondence  between  the  suggestions  derived 
from  the  testimony  of  the  physical  organs,  and  the  calm  deduc- 
tions of  the  logical  faculty,  aided  by  a  disciplined  and  well  fur- 
nished memory. 


CHAPTEE  in. 
SURGICAL  THERAPEUTICS. 

This  title  refers  to  one  of  the  most  extensive  and  important 
departments  of  surgical  practice,  upon  which,  indeed,  as  to  its 
proper  administration,  depends  in  a  great  measure  the  success  of 
the  operative  skill,  of  which  it  is  the  supplement  and  consummation. 
It  comprehends  the  bandaging  and  dressing  of  traumatic  injuries. 

DRESSINGS. 

Gourdon  says  that  "  a  dressing  is  a  mode  of  local,  periodically 
repeated,  treatment,  producing  a  continued  action,  following  or- 
dinarily the  performance  of  operations,  and  consisting  in  the 
methodical  appUcation  upon  the  surface  of  wounds  of  special 
apparatuses,  which  complete  the  effect  of  the  operation,  and  co- 
operate in  the  recovery." 

The  value  of  the  skill  and  proficiency  to  be  acquired  by  dili- 
gent study  and  observation  in  this  comprehensive  and  indispen- 
sable art,  need  not  be  stated ;  that  it  is  entitled  to  be  so  denomin- 
ated no  one  acquainted  with  the  niceties  of  its  details  and  the 
judgment  and  experience  entering  into  their  performance,  need  be 
told.  Nor  can  the  dependence  of  the  surgeon,  for  the  good  results 
which  he  hopes  to  secure  in  his  department  of  duty,  upon  the 
faithfulness  and  intelligence  of  the  nurse,  who  is  to  co-operate 
with  him  in  perfecting  the  healing  process,  be  easily  overrated. 
An  incompetent  or  unfaithful  nurse,  may  spoil  the  best  work  of  a 
good  surgeon.  To  protect  a  wound  from  immediate  contact  of 
surrounding  bodies,  to  shield  it  from  injurious  atmospheric  effects, 
malarious  or  otherwise;  to  keep  aloof  all  putrid  and  virulent  mat- 
ters ;  to  secure  the  absorption  and  neutralization  of  their  morbid 
products;  to  control  the  cicatrizing  process  in  the  ulcerated 
parts ;  to  apply  topical  treatment,  according  to  indications,  as 
the  curative  processes  develoj) ;  to  produce  a  mechanical  action, 
such  as  dilatation  or  compression,  according  to  the  instructions 


DRESSINGS.  91 

of  the  surgeon,  and  the  indications  of  the  case.  Such  is  a  fair, 
though  brief  synopsis  of  the  duties  of  the  niu'se,  upon  whom  it 
devolves  to  give  effect  to  the  rules  of  surgical  therafpeutlcs. 

A  well-ai:)pLied  di-essing  may  become  the  first  stej)  toward 
assuring  the  success  of  an  operation,  those  following  it — even 
when  only  methodically  executed — being  mere  continuous  degrees 
of  the  one  well  begun  action.  A  well-apphed  dressing  may  sup- 
ply the  defects  and  amend  the  errors  of  an  improperly  performed 
operation;  and,  on  the  other  hand,  a  bad  dressing  may  jeopardize 
the  success  of  a  well-executed  operation  by  interfering  with  the 
process  of  cicatrization,  and  in  other  ways  delay  the  recovery  of 
the  patient,  and  even  prevent  it  entirely,  by  causing  unfavorable 
complications. 

The  application  of  all  dressings  is  subject  to  certain  general 
rules,  from  which  no  deviation  is  allowable.  As  in  every  action  in 
life,  the  first  step  should  be  that  of  preparing  all  the  necessary 
means  and  apphances  for  the  work,  and  the  last,  before  beginning 
the  actual  manipulation,  should  be  to  ascertain  that  nothing  more 
remains  to  be  provided,  at  the  risk  of  a  serious  interruption  and 
delay,  and  loss  of  time  in  a  search  for  some  missing  article  of 
necessity.  On  such  a  point  the  merest  hint  should  be  sufficient, 
and,  indeed,  even  a  hint  should  be  unnecessary  with  a  practical 
and  thoughtful  person;  but,  unfortunately,  all  persons  are  not 
practical  and  thoughtful. 

The  next  step  for  the  surgeon  is  to  secure  for  himself  and  his 
patient  a  favorable  arrangement  in  resj^ect  to  hght  and  room. 
There  must  be  nothing  interposed  before  the  eye,  or  that  can  limit 
the  free  movement  of  the  hand  and  the  arm — a  most  obvious  sug- 
gestion. 

Before  applying  a  dressing,  the  wound  should  be  thoroughly 
cleansed  and  freed  from  blood,  pus,  the  remains  of  previous 
dressings,  and,  in  a  word,  of  any  foreign  or  other  substances 
capable  of  becoming  sources  of  irritation.  This  is  best  done 
with  water  alone,  but  its  effect  is  frequently  greatly  improved  by 
combining  with  it  some  of  the  compounds,  such  as  carbolic  acid, 
sanitas,  creoline,  etc.,  which  have  proved  their  value  as  antiseptic 
agents.  It  may  be  applied  by  carefully  passing  a  fine  sj)onge  or 
a  ball  of  oakum  over  the  siu'face  of  the  wound,  or  it  may  be  used 
more  freely  in  larger  ablutions.  Crusts  or  scabs,  if  any,  may  be 
removed  with  the  scissors  or  scraped  away  with  the  spatula,  but 


92  SUEGICAL    THERAPEUTICS. 

the  finger-nails  must  by  no  means  be  used  for  such  a  purpose, 
for  the  twofold  reason  that  it  is  both  filthy  and  dangerous. 
Handle  the  wound  only  as  much  as  is  necessary;  all  needless 
taxis  irritates — the  inference  is  obvious.  If  the  wound  is  deep, 
injections  can  be  combined  with  the  lotions  in  cleansing  it. 

With  the  first  dressing,  there  is  probably  only  blood  to  wash 
away,  and  that  should  be  done  thoroughly,  not  overlooking  any 
portion  that  may  have  dried  in  the  haii-  and  on  the  skin.  The 
essential  condition  of  cleanliness  applies  not  only  to  the  wound, 
but  also  to  the  material  used  for  the  dressing,  and  soiled  cloths 
or  bandages,  and  dii'ty  tow  or  oakum  must  be  rigorously  rejected. 
And,  while  insisting  on  strict  cleanhness  in  the  instruments  and 
dressing  material,  it  will  hardly  be  decorous  to  the  surgeon  to 
omit  him  from  the  category,  and  to  remind  him  of  the  propriety 
of  looking  to  his  own  condition,  and  especially  to  that  of  his 
hands. 

In  all  his  manipulations  it  should  be  a  matter  of  conscience 
with  the  surgeon  to  treat  his  patient  kindly.  Rough  handling, 
loud  scolding,  threatening  or  jerking,  with  a  restless  animal,  to 
pimish  him  for  an  instinctive  and  natural  attempt  to  move  under 
the  infliction  of  pain,  will  not  only  be  of  no  service,  but,  on  the 
contrary,  will  increase  his  fright  and  render  him  all  the  less  docile 
and  willing  to  submit  in  quietness. 

In  applying  the  various  parts  of  the  dressings,  unnecessary 
pressure  should  be  avoided,  esjpeciaUy  on  soft  tissues ;  and  when 
it  is  indicated,  it  should  be  apphed  by  slow  degrees,  and  as  imi- 
formly  as  possible,  packing  the  wound  upon  its  entire  surface, 
and  completed  only  as  the  dressing  is  nearly  ended.  Assistants 
should  be  enjoined  to  observe  the  same  rules.  The  dressing 
should  be  apphed,  not  hastily,  but  rapidly;  not  with  the  idea  of 
saving  time,  simply  with  a  view  to  lose  none.  The  fact  of  avoid- 
ing any  waste  of  time,  by  working  without  needless  pause,  has, 
moreover,  the  excellent  effect  of  curtailing  the  sufferings  of  the 
patient,  and  sparing  him  much  needless  j)ain. 

It  is  always  important  to  watch  the  effect  of  the  various  arti- 
cles of  dressing  as  they  are  apphed,  in  order  to  be  certain  that 
they  cause  no  pain  either  at  the  time,  or  at  a  later  period  by  their 
shape,  the  roughness  of  their  surface,  or  their  unskillful  apjolica- 
tion ;  and  above  aU,  that  they  cause  no  interference  with  any  of 
the  essential  functions  of  the  economy,  as  the  respii-ation  or  cu-- 


DRESSINGS.  93 

culation.  This  last  especially  may  be  impeded  by  excessive  pres- 
sure. To  avoid  this,  bandages  apphed  upon  one  of  the  extremities 
of  the  body  should  be  so  placed  as  to  dii-ect  the  pressure  from  the 
periphery  toward  the  center.  If  applied  in  the  opposite  direction, 
more  or  less  strangulation  might  result,  causing  considerable 
swelliug  below  the  bandage.  In  fact,  all  unnecessary  or  exag- 
gerated pressure  is  liable  to  cause  inflammatory  swellings,  erysip- 
elous  engorgements,  or  local  gangrenes. 

The  maintenance  of  an  equal  and  regular  pressiu'e  will  obviate 
all  danger  of  deformities  of  parts,  and  when  methodically  applied 
upon  ii'regular  wounds,  wherever  needed,  will  serve  to  restore  or 
preserve  them  in  the  natural  contour  of  the  region.  Neatness 
and  finish  should  be  studied  as  much  as  possible,  but  not,  of 
course,  at  the  expense  of  any  of  the  special  and  essential  objects 
of  the  dressing. 

Besides  these  general  rules  there  are  others  relating  to  minute 
points  and  touching  the  various  elements,  which,  as  a  combined 
whole,  constitute  the  completed  transaction,  such  as  those  relating 
to  the  topical  treatment,  to  the  material  used,  to  the  rollers  or 
bands,  and  to  the  bandages  proper.  The  medicinal  compounds 
used  for  topical  treatment  are  either  appHed  alone  or  through  the 
medium  of  other  materials.  They  are  of  various  natures  and  con- 
sistencies, from  that  of  the  almost  impalpable  vapor  used  for 
spraying,  to  the  hquid  forms  in  the  numerous  watery  solutions, 
alcoholic  tinctures,  and  oils  or  hniments,  to  the  hard  and 
other  soHd  compounds  in  the  various  astringent,  absorbing,  stimul- 
ating or  caustic  powders,  or  the  soft  pharmaceutical  mixtures, 
the  cerates,  the  pomades,  the  ointments,  the  plasters,  poul- 
tices, etc. 

The  apphcation  of  the  material  used  should  receive  attention 
from  the  surgeon.  An  invariable  rule  should  be  to  avoid  all  ir- 
regularity, roughness  and  unevenness,  and  to  be  careful  that  the 
exterior  application  rests  upon  a  regular  and  uniform  surface. 
For  this  reason  it  should  be  the  order,  hi  applying  this  material, 
always  to  begin  by  using  the  smallest  portions,  increasing  gradu- 
ally to  the  largest,  thus  filling  first  the  smaU  infractuosities  and 
making  an  even  surface,  to  be  covered  with  larger  ones  and  thin 
pads,  then  with  thicker  ones,  and  finally  with  those  of  the  widest 
dimensions,  which  should  bear  a  margin  extending  somewhat  be- 
yond the  outlines  of  the  wound.     The  entire  dressing  is  to  be 


94  SUEGICAL    THERAPEUTICS. 

maintained  in  position  by  means  of  compresses,  rollers  or  band- 
ages, as  the  case  may  require. 

Kollers  are  long  bands  of  muslin,  linen,  or  ticking,  or  broad 
tapes,  which,  are  used  principally  in  dressing  wounds  of  the  ex- 
tremities, or  of  regions  liable  to  much  motion.  Their  length  and 
width  vary,  according  to  the  requirements  of  the  case.  The  sur- 
geon will  do  well  to  assure  himself  of  the  dimensions  of  these, 
and  to  ascertain  that  the  rollers  are  of  ample  length,  with  some- 
thing to  spare,  which  excess  in  length  can  be  cut  off.  Deficiency 
in  the  length  of  a  roller  will  interfere  with  a  perfect  completion 
of  its  application.  If  too  wide,  it  may  prove  difficult  to  ajpply  it 
neatly,  while  if  too  narrow  it  may  have  a  tendency  to  act  like  a 
hgature,  and  make  even  pressure  difficult,  besides  being  more 
liable  to  slip  and  become  loosened.  Kollers  are  appHed  either  dry 
or  moist.  When  moist,  they  become  loose  in  dri^-ing,  and  their 
action  becomes  insvifficient.  Dry  rollers  ought,  therefore,  to  be 
preferred. 

Bands  or  rollers  are  prepared  in  two  ways,  either  by  being 
rolled  on  one  or  on  both  of  their  extremities,  and  are  therefore 
called  the  single  or  the  double  roller.     In  a^jplying  it,  the  extrem- 


is ui.  83.— Single  and  Double  Roller  Bandage. 

ity  is  first  folded  tightly  to  make  a  small  cylinder,  which  is  held 
by  its  extremities  between  the  thumb  and  index  finger  of  the  left 
hand,  resting  by  its  width  between  the  same  fingers  of  the  right ; 
and  while  the  fingers  of  the  left  hand  turn  the  small  central  cylin  ■ 
der,  the  band  is  rolled  upon  it  to  its  end.  Kolling  on  both  ends 
is  done  in  the  same  manner.  When  half  of  it  is  rolled,  a  pin  will 
secure  it  and  prevent  it  from  becoming  slack  until  the  other  half 
is  made  ready  to  be  used.  In  rolHng  the  bands,  slight  traction 
should  be  made  at  intervals  by  the  thumb  of  the  right  hand,  while 
the  fingers  of  the  left  keep  the  central  cylinder  steady — the  object 
of  which  is  to  have  the  roller  firm,  hard  and  solid. 

In  large  establishments,  or  even  in  jDrivate  practice  where 
great  numbers  may  be  required,  the  use  of  the  smaU  apparatus 
represented  in  Figure  85  will  be  found  very  advantageous,  the 


95 


Fig.  84.— Manner  of  Roliug  a  Bandage. 

band  being  rolled  upon  the  central  rod  with  facility,  and  when 
removed  having  the  necessary  qualities  of  a  well-rolled  bandage. 
The  general  manner  of  applying  a  roller  bandage  is  very  simjjle. 
Placing  with  one  hand  the  end  of  a  single  roller,  or  the  middle  of 
a  double  one,  upon  the  part  to  be  covered,  and  keeping  it  steadily 
in  position,  the  other  hand  holding  the  mass  of  the  bandage  with 


Fig.  85.— Bandage  Roller. 


96  SURGICAL    THEBAPEUTICS. 

the  roll  turned  upwfird,  gently  draws  on  it  away  from  the  start- 
ing point,  unrolls  it,  and  with  it  surrounds  the  entire  region  in 
retiu-ning  to  the  starting  point.  This  process  is  continued  until 
the  band  is  exhausted,  when  it  is  secured  by  j)ins  or  by  strings. 
Thus  appUed,  it  may  be  laid  in  a  circular  manner,  when  the  turns 
rest  exactly  upon  each  other,  or  in  a  spiral  manner  when  they 
overlap  each  other  in  part  of  their  width,  or  in  a  crossed  or  figure 
of  eight  manner,  when  the  turns  cross  each  other  to  meet  always 
at  a  given  point.  If  they  are  applied  upon  cylindrical  surfaces, 
the  folds  generally  He  smoothly  and  evenly  upon  each  other  as 
they  are  successively  formed,  but  if  the  region  is  of  conical  shape 
or  otherwise  irregular  in  form,  one  of  the  borders  will  adapt  itself 
more  readily  to  the  parts  than  the  others.  Hence  the  formation 
of  bulging  parts  or  pockets,  which  render  the  smooth  and  proper 
apphcation  of  the  bandage  very  difficult,  and  may  interfere  with 
its  sohdity.  This  is  avoided  by  giving  to  the  roller  an  obUque 
half  twist,  which,  while  it  changes  the  gaping  border  in  its  posi- 
tion, prevents  the  slackening  of  the  bandage  and  removes  the 
pocket.  This  is  principally  required  in  the  bandaging  of  the  lower 
part  of  an  exti-emity  (Fig.  86). 

The  apphcation  of  bands  on  double  roUs  is  also  subject  to  the 


Fig.  80.— Uow  to  Apply  a  Bdndage. 


DRESSINGS.  97 

rules  we  iiave  given.  The  completion  of  the  process  by  the  appli- 
cation of  the  final  dressings  and  proper  finishing  steps  can  scarce- 
ly be  subjected  to  rules  which  could  not  well  be  framed  to  meet  the 
varieties  in  the  features  and  circumstances  of  the  diversified  cases 
constantly  occurring  in  practice.  The  only  strictly  general  rule 
that  can  be  established,  is,  that  when  a  bandage  is  placed  on  the 
outside  of  a  dressing,  it  must  always,  first  of  all,  be  fixed  at  the 
points  which  are  the  most  essential  to  secure  it  and  maintain  it  in 
its  proper  place. 

The  proper  time  for  the  removal  or  change  of  a  dressing,  is  a 
question  which  depends  for  an  answer  upon  the  consideration  of 
the  nature  of  the  wound,  the  season  of  the  year,  the  age  and  con- 
dition of  the  j)atient ;  in  fact  upon  all  the  various  circumstances 
which  in  the  judgment  of  the  surgeon  may  influence  the  progress 
of  the  cicatrization. 

On  general  principles,  the  first  di-essing  is  not  to  be  removed 
until  the  sujopurative  process  is  thoroughly  established,  which  is 
towards  the  fourth  or  fifth  day.  But  there  are  cases  where  special 
circumstances  indicate  an  earUer  or  a  later  removal.  For  examjDle, 
if  the  dressing  has  been  applied  to  control  the  hemorrhage  of  a 
divided  blood  vessel,  from  twenty-four  to  thirty-six  houi'S  are 
generally  sufficient  to  obtain  the  obHteration  of  the  vessel. 
Again,  while  it  is  justifiable  to  leave  the  dressing  of  a  foot,  which 
has  been  subjected  to  an  operation,  for  eight,  fifteen,  twenty,  and 
even  twenty-five  days  without  changing,  and  especially  in  these 
days  of  antiseptics  when  so  much  is  possible  in  the  way  of  com- 
bating the  suppurative  process,  there  are  no  doubt  cases  where 
it  must  be  looked  after  earher,  as  where  there  is  an  exhibition  of 
increased  pain,  instead  of  the  abatement  which  might  be  justifi- 
ably looked  for  if  the  operation  and  the  dressing  had  been 
properly  executed;  the  increase  of  pain  indicating  some  compli- 
cations which  early  exposure  might  easily  have  controlled.  There 
are,  however,  conditions  where  the  removal  of  a  dressing  is  in- 
dicated in  some  more  than  in  others,  as,  for  instance,  when  sup- 
puration is  abundant.  In  these  cases,  to  prevent  the  retention  of 
the  pus  in  the  wounds,  and  to  diminish  the  danger  of  its  pres- 
ence, or  of  its  absorption,  or  facilitate  its  escape,  di-ainage  tubes 
must  be  used,  or  the  dressing  changed. 

The  removal  of  a  first  dressing  usually  involves  an  attention 
to  minute  details  not  subsequently  required,  the  various  parts 


98  SURGICAL    THERAPEUTICS. 

which  compose  it  being  often  impregnated  with  blood  and  glued 
together  by  concreted  pus,  causing,  if  removed  carelessly,  the 
laceration  of  tissues,  tearing  of  granulations,  hemorrhages,  etc. 
It  must  especially  be  ascertained  whether  adhesions  exist  between 
the  material  of  the  dressing,  and  if  they  are  present  they  must 
be  thoroughly  soaked  by  means  of  compresses  wet  with  tepid 
water,  or  a  warm  water  bath,  if  the  dressing  is  upon  a  region 
which  allows  it,  as,  for  instance,  one  of  the  extremities.  When 
this  is  done,  the  various  constituents  of  the  dressings  may  easily 
be  removed,  one  by  one,  but  care  and  deliberation  will  still  be 
necessary.  The  smaller  particles  should  be  removed  with  the 
forceps,  not  the  fingers.  If  the  location  allows  it  we  even  prefer 
to  wash  these  away  by  irrigation,  with  a  stream  of  luke-warm 
water,  or  by  soaking  thoroughly  in  a  foot  bath.  The  wound  is  to 
be  cleaned  out  carefully,  by  soaking  or  sopping  away  the  pus  with 
fine  sponges,  avoiding  all  rubbing  upon  the  granulations  or  caus- 
ing them  to  bleed.  Then  studying  all  the  indications,  to  be  dis- 
covered in  the  condition  of  the  wound,  and  avoiding  aU  unneces- 
sary manipulations,  and  attentively  removing  all  causes  likely  to 
interfere  with  the  repairing  processes,  the  di'essing  is  to  be  re- 
placed with  all  the  original  precautions.  As  little  time  as  possi- 
ble, consistent  with  thoroughness,  should  be  occupied  in  this 
process.  The  wound  should  be  uncovered  only  as  long  as 
necessity  requires,  the  materials  for  the  dressing  being  all  easily 
accessible  without  delay  or  hindrance,  being  prepared  in  advance 
and  carefu^Uy  inspected. 

The  effects  looked  for  in  the  application  of  dressings  can  be 
divided  into  general  and  special,  these  varying  in  their  natin'e, 
according  to  the  object  which  the  surgeon  has  in  view.  The 
first  and  principal  object  is  to  protect  the  wound  from  exposure 
to  the  action  of  the  atmosphere,  and  also  against  contact  with 
foreign  bodies,  thus  to  relieve  the  pain,  diminish  the  inflammatory 
irritation,  and  accelerate  the  cicatrization.  It  also  prevents  the 
retention,  by  their  absorption  of  the  suppuration  and  serosity 
which  form  on  the  surface.  They  also  expedite  recovery  b}' 
maintaining  the  natural  warmth  of  the  body  in  the  region. 
The  sp>ecial  effects  of  dressing,  vary  according  to  the  special 
action  produced  by  their  application,  and  these  may  be  considered 
under  several  heads. 

{a)  Retentive  dressing. — This  is  designed  to  keep  parts  in  their 


RETENTIVE    DRESSING.  99 

normal  condition  and  situation,  and  tlius  aid  in  tlierr  union  or  con- 
solidation, without  deformity.  It  is  principally  applied  xa  cases  of 
fractures  or  dislocations,  but  finds  also  its  main  indication  in 
maintaiuing  in.  their  proper  place  the  mediciual  substances  which 
are  the  active  agencies  of  cure. 

(b)  Uniting  dressing. — That  which  is  made  with  sutures  or 
adhesive  plaster,  to  hold  the  parts  in  their  proper  position,  and 
maiatain  their  perfect  co-aptation. 

(c)  The  suspensory  dressing,  which  is  a  variety  of  the  reten- 
tive dressing,  and  serves  to  support  organs  of  soft  textiu-e  in 
some  parts  of  the  body,  such  as  the  testicles,  or  the  mammae, 
which  by  their  position  are  exposed  to  traumatism  by  their  sit- 
uation, their  weight,  and  by  pulling  and  bruises.  Susjyensories, 
is  the  name  given  to  these  special  bandages ;  they  are  commonly 
used  in  diseases  of  the  testicles,  and  of  the  udder. 

{d)  Compressive  dressings. — These  are  devised  to  produce 
more  or  less  active  pressure  upon  a  too  active  granulating  sur- 
face ;  to  arrest  hemorrhage,  to  change  the  vitaHty  of  some  tissues 
of  a  morbid  nature,  or  to  control  the  projection  of  abnormal  bony 
growths. 

(e)  The  dividing  dressing  is  the  opposite  to  the  uniting.  It 
is  of  common  use  ia  cases  where  too  rapid  closing  of  wounds  is 
to  be  prevented.  It  is  applicable  in  infundibuliform  surfaces,  ia 
deep  fistulous  tracts,  and  in  wounds  which  are  the  seat  of  foreign 
elements,  pathological  or  other.  It  operates  by  keeping  the 
superficial  opening  of  the  wound  dilated,  by  means  of  tents, 
sponges,  etc. 

(/)  Expulsive  dressing. — The  object  of  this  dressing  is  to 
assist  the  exit  of  pus  from  the  surface  of  wounds.  A  simple  dress- 
ing, by  its  absorbing  properties,  is  somewhat  of  an  expulsive  na- 
ture. The  presence  of  a  single  tent  of  an  absorbing  quality,  as 
small  balls,  or  padding  of  absorbent  cotton;  the  application  of 
drainage  tubes ;  all  these  facilitate  not  only  the  escape  of  the 
secretions,  but  also  the  discharge  of  the  morbid  products.  The 
drainage  is  obtained  by  the  introduction  into  the  wound  of  India 
rubber  tubing,  of  various  dimensions,  perforated  at  intervals  upon 
their  length,  and  kept  in  position  by  safety  pins  inserted  through 
them  and  the  skin,  at  suitable  points.  These  tubes,  when  extend- 
ing through  the  depth  of  a  wound,  embracing  its  whole  length,  and 
projecting  through  a  counter  opening,  as  well  as  through  the 


100  SUKGICAL    THERAPEUTICS. 


Fig.  87.— Safety  Pins. 

natural  ones  of  the  wound,  form  an  excellent  means  for  contin- 
uous ixTigation,  in  the  treatment  of  fistulous  withers,  comj)Hca^ 
ted  poll  evil  and  other  diseases. 

(ff)  Antiseptic  ih-essiiig. — Is  intended  to  prevent  the  entrance 
of  micro-organism  into  wounds,  to  neutralize  their  morbific  ef- 
fect, to  check  their  development,  and  thus  prevent  their  septic  in- 
fluences from  taking  effect.  The  apj)lication  of  the  Lister  dress- 
ings, with  the  care  required  in  the  preparation  and  application 
by  the  surgeon  ;  of  the  instruments  and  materials  included  in  the 
arsenal  of  pharmaceutical  resources,  comprising  the  antiseptic 
sprays ;  the  various  acids,  boracic,  carbolic,  and  salycilic ;  the 
alkaline  sulphites  and  hyposulphites;  joermanganate  of  potash; 
solutions  of  bichloride  of  mercury  and  of  creoline;  antiseptic 
gauze  and  absorbent  cotton — all  these,  and  more  constitute  dress- 
ings essentially  germifide,  which  cannot  be  too  confidently 
recommended  to  the  attention  and  adoption  of  the  veterinary 
surgeon. 

The  apphcation  of  the  wadding  dressing,  so  highly  recom- 
mended by  some,  has  given,  in  our  hands  very  satisfactory 
results,  in  many  cases.  Wadding  well  prepared  and  properly 
appHed,  forms  an  almost  invincible  obstacle  to  the  introduction 
of  micro-organisms,  and  according  to  Pasteur,  by  its  direct  action 
upon  the  pus  renders  fermentation  impossible. 

The  instruments  necessary  for  the  adjustment  of  dressings, 
are  generally  speaking,  numerous  and  varied.  They  consist  of 
forceps  of  all  kinds,  the  ordinary  dissecting,  the  buU-dog,  the 
straight,  and  the  curved  dressing  forceps;  scissors,    directors. 


ANTISEPTIC    DRESSING. 


101 


Fig.  88.— Dissecting  Forceps. 


Fig.  92.— Syringi;  f-r  Uresbing. 

spatulas,  the  8.  probe,  and  others ;  syringes,  and  sometimes 
atomizers,  and  also  razors,  enter  into  the  list  of  those  generally 
needed. 

The  materials  used  to  form  the  base  of  the  dressings  vary : 
charpie,  wadding,  wool,  moss  and  sponges,  are  employed.  Their 
costliness  as  respects  their  commercial  value,  is  probably  the 
reason  why  they  are  not  more  generally  adopted  in  the 
practice  of  veterinarians.     Oakum  is  the  material,  par  excellence, 


102  SURGICAL    THERAPEUTICS. 

for  the  application  of  dressings  in  veterinary  surgery,  and  is  even 
commonly  used  in  human  surgery.  We  are  almost  tempted  to 
claim  for  it  the  distinction  of  having  been  especially  created  for 
the  benefit  of  wounded  horses,  its  various  and  valuable  qualities 
so  obviously  fitting  it  for  the  uses  to  which  it  is  appropriated  in  the 
equine  chnic.  It  is  excellent  as  a  defense  against  the  contact  of 
external  bodies,  and  in  preserving  a  uniform  temperature  in  the 
parts  covered  by  it.  From  the  sponginess  of  its  consistency  it 
readily  soaks  and  absorbs  the  fluids  which  form  uj)on  the  surface 
of  a  wound,  while  the  tar  with  which  it  is  more  or  less  imi^regnated 
confers  upon  it  slight  antiseptic  properties,  which  assist  in  the 
stimulation,  and  ai'e  in  themselves  favorable  to  all  the  processes 
of  cicatrization.  To  be  of  good  quality,  it  must  be  clean,  soft  to 
the  touch,  and  free  from  any  foreign  substance.  Sometimes  it  is 
cut  into  small  portions  for  use,  but  more  generally  in  strips,  or 
in  such  other  special  shapes  as  may  be  required.  It  is  made  into 
balls  by  spreading  out  little  masses  of  the  fibres,  which  after  being 
separated  from  each  other,  are  rolled  between  the  hands,  into  the 
required  forms  and  sizes.     They  are  exceedingly  convenient  in 


Pig.  93.— Ball  of  Oakum. 

constituting  the  first  steps  of  this  aj)plication  of  a  dressing.  It  is 
also  made  into  ^:)ar?s  or  cushions,  by  stretching  the  fibres  parallel, 
into  any  given  width  and  length,  and  folding  them  into  the  simil- 
itude of  a  small  mattress.  This  must  be  soft,  and  free  from 
lumps,  or  fragments  of  wood,  and  of  an  even  thickness  through- 


FiG.  94.— Pad  of  Oakum. 

out.  These  are  made  also  of  various  dimensions,  the  widest  and 
thickest  being  used  to  cover  the  outside  of  the  wound.  It  is  also 
shaped  into  dossils,  rolls,  and  tents,  or  2:)liigs,  the  adaptation  of 
which  remains  yet  to  be  considered. 


103 


BANDAGES 


The  catalogue  of  means  and  appliances  for  di-essing  is  by  no 
means  exhausted  in  those  already  mentioned.  Among  them  are 
the  various  forms  of  compresses,  the  rollers,  the  splints,  the  plates 
and  the  means  of  drainage,  with  the  various  forms  of  rolled  ban- 
dages, wide  bandages  and  mechanical  bandages. 

(a)  Coinjoresses. — These  are  pads  made  of  linen,  of  various 
sizes  and  shapes,  and  folded  to  any  degree  of  thickness  required, 
which  are  sometimes  aj^plied  immediately  upon  the  wound,  but 
usually  uj)on  the  oakum.  They  are  not,  however,  of  frequent  use 
in  veterinary  surgery,  excej)t  under  special  indications.  They 
may  be  square,  long,  triangular,  shaped  like  a  neck-tie,  or  like  a 
Maltese  cross,  either  complete  or  half,  double  or  treble-tailed,  and 
generally  patterned  and  graduated  according  to  the  form  required 


wii 


-Square  Compress. 


Fig.  96.— Long  Compress. 


Fig.  97.— Triangular 
Compress. 


Fig.  98.— Neck-Tie  Compress. 


Fig.  99.— Maltese  Cross  Complete. 


Fig.  100.— Half  Maltese  Cross  Complete 


Fig.  101.— Double  Compress. 


Fig.  102.— Treble  Compress. 


104 


SURGICAL    THERAPEUTICS. 


Fig.  104.— Perforated  Compress. 


Fig.  103.— Graduated  Compress- 


by  the  case.  Tliej'  are  commonly  used  in  tlieir  entire  thickness, 
but  are  sometimes  made  with  a  hole  in  their  center,  and  then 
receive  the  name  of  perforated  or  fenestrated. 

(Jb)  Rollers  have  already  occupied  our  attention. 

(c)  Splints. — These  are  long,  flat,  and  more  or  less  rigid  strips 
of  wood,  or  other  material,  designed  to  be  added  to  other  dress- 
ings, to  give  them  some  j)eculiar  form  or  position,  and  to  consoh- 
date  and  strengthen  them  by  increasing  their  rigidity.  They  are 
usually  api^lied  upon  the  extremities  or  superior  parts  of  the  body, 
and  are  composed  not  only  of  wood,  but  of  hard  leather,  paste- 
board, tin,  gutta-percha,  etc.,  etc.,  and  maintained  in  jiosition  by 
bands  or  adhesive  mixtures.  They  must  be  carefully  and  accu- 
rately applied  in  order  to  avoid  chafing  or  excoriating  the  skin, 
and  are  often  padded,  and  their  borders  made  especially  smooth 
and  uniform. 

{d)  Plates. — These  are  small  pieces  of  metal  or  wood,  need 
principally  in  the  sui'gery  of  the  foot,  to  keej^  in  place  dressings 
of  the  i^lantar  region,  which  require  more  or  less  pressure  upon 


Fig.  105.— Plates  on  Shoes. 


BANDAGES.  105 

theii*  surfaces.  They  consist  of  separate  parts  or  sections,  repre- 
senting together  the  entii-e  surface  of  the  sole,  one  section  sUding 
on  each  side,  between  the  foot  and  shoe,  and  are  kept  in  place  by 
a  third  and  narrower  section,  introduced  transversely  between  them 
and  the  shoe,  towards  the  heel.  It  is  important  to  ascertain,  be- 
fore applying  them,  that  sufficient  room  exists  between  the  sole 
and  the  shoe,  and  also  that  the  wall  is  not  in  such  close  contact 
with  the  shoe  at  the  heels  as  to  prevent  the  introduction  of  the 
cross  pieces. 

(e)  3Iean8  of  Drainage. — The  conduit  most  commonly  used  is 
a  vulcanized  india-rubber  tube,  which  is  introduced  into  wovmds 
to  facilitate  the  escape  of  purulent  and  other  discharges,  and  to 
keep  them  in  a  cleanly  state.  They  are  of  various  dimensions,  as 
to  the  length  and  diameter,  to  accommodate  those  of  the  purulent 
cavity,  and  are  perforated  at  the  side  throughout  their  length,  in 
order  to  collect  and  receive  aU  the  impm-ities  that  may  be  present. 
Instead  of  tubes,  long  tents  of  oakum  are  sometimes  introduced 
into  a  wound,  for  the  pur2oose  of  absorbing  the  imjjurities,  and  to 
serve  as  a  means  of  drainage  also. 

(/)  Holler  Bandages. — These  are  the  simplest  of  bandages. 
They  are  applied  with  one  or  several  rollers.  We  have  ah-eady 
mentioned  their  division  into  cii'cular,  spu'al,  figure  8,  etc. 

{g)  Wide  Bandages  are  made  of  broad,  thin  pieces  of  linen, 
ticking  or  canvas  in  various  forms,  to  adapt  themselves  to  any 
part  of  the  body  where  they  may  be  needed.  They  are  sometimes 
folded  into  pads  or  cushions,  and  employed  as  a  means  of  applying 
moisture.  Those  invented  by  Dr.  Berns  (Fig.  lOG)  for  this  purpose 
may  be  used  with  advantage.  They  are  kept  in  place  by  tapes 
or  ribbons,  which  must  be  arranged  and  fastened  about  the  body 
according  to  the  judgment  and  ingenuity  of  the  surgeon. 

The  number  of  wide  bandages  is  indefinite,  and,  according  to 
Bourgelat,  twenty-seven  species  can  be  classified  and  enumei'ated. 
He  would  prove  himself,  however,  but  an  indifferent  practitioner 
who  should  find  himself  unable,  upon  occasion,  to  improve  the 
catalogue  by  adding  new  devices  to  meet  new  requii-ements. 

In  examining  some  of  the  principal  varieties  of  the  wide  ban- 
dage, we  shall  borrow  from  the  excellent  work  of  Peuch  and 
Toussaint.     Our  reference  will  be  to 

1st.  S'lmj^le  Frontal. — This  is  a  piece  of  cloth  covering  the 
greater  part  of  the  forehead  and  the  summit  of  the  head  or  poll, 


106 


SURGICAL    THERAPEUTICS. 


tib  100  — Bems  Mo  stened  rada 

with  a  fold  superiorly  to  receive  the  forelock  or  toupet,  and  se- 
cured by  four  bands.  The  lower  two  have  either  a  small  opening 
or  loop,  which  the  upper  two  pass  before  extending  down  below 
the  throat,  to  cross  each  other  in  the  form  of  an  X,  and  drawn 
upwards  in  the  lateral  faces  of  the  head  to  the  poll,  where  they 
are  held  (Figs.  107, 108). 

2d.  Gomrpound  Frontal.  —  This  is  shaped  like  the  formei;, 
but  extends  further  down  on  the  face.  It  has  six  bands,  the 
middle  ones  having  also  Ioojds  at  their  free  extremity,  as  in  the 
preceding,  the  upper  ones  being  also  secured  in  the  same  manner, 
the  lower  ones  crossing  each  other  under  the  jaws,  and  also 
carried  upward  to  pass  through  the  loops  of  the  middle  bands, 
to  be  either  tied  on  the  poll,  or  drawn  downwards  and  tied  in  the 
maxillary  space  (Figs.  109,  110). 


107 


Fig.  107.— Simple  Frontal  (full  view)  Fig.  108.— Simple  Frontal  (side  view). 


Fig.  109.— Compound  Frontal  (full  view).         FiG.  110.— Compound  Frontal  (side  view). 

3d.  MonooAilar  or  Simple  Bandage  for  the  Eye.  This  is  an 
oblong  square,  notclied  at  the  angles,  coi^responding  to  the  ear  of 
the  same  side,  and  provided  with  two  transversal  folds,  to  adapt 
itself  to  the  convexity  of  the  orbit.  It  is  secured  by  five  bands. 
The  upper  three  are  attached  to  the  throat-strap  of  the  halter  or 
bridle,  the  lower  two  to  the  lower  part  of  the  same  strap  (Figs.  Ill, 
112). 

4th.  JBinocular  or  Double  Bandage  for  the  Eye. — This  is 
formed  of  a  large  piece  of  cloth,  notched  on  its  two  superior  an- 
gles to  receive  the  ears,  and  secured  with  eight  strings  or  straps. 
A  longitudinal  fold  in  the  upper,  and  another  in  the  lower  part 


108 


SURGICAL    THERAPEUTICS. 


Fig.  111.— Monocular  Band  (full  view). 


Fig.  112.— Monocular  Band  (side  view). 


of  the  bandage,  facilitate  its  adaptation  to  the  surfaces  it  is  to 
cover  (Figs.  113,  111). 

5th.  Bandage  for  the  Maxillary  Region. — This  is  of  triangular 
shape,  and  is  formed  either  of  sheepskin  or  of  two  layers  of  cloth, 
between  which  a  pad  of  oakum  is  sewed.  It  is  furnished  with 
four  straps.  When  apj^lied,  the  base  of  the  triangle  is  turned 
backward,  and  the  apex  rests  in  the  angle  of  the  maxillary  space. 
The  two  upper  straps,  attached  at  each  angle  of  the  base  of  the 
triangle,  pass  upward  at  the  side  of  the  parotids,  and  are  tied  on 
the  summit  of  the  head,  the  two  lower  ones  attached  at  the  apex 
of  the  triangle,  passing  over  the  nose  to  be  tied  at  that  point.  We 
have  often  obtained  a  better  adaj)tation  of  this  bandage  by  utiliz- 
ing the  cheek  or  the  nose-piece  of  the  halter 

6th.  Ear  Bandage  (Figs.  115,  IIG). — This  is  made  of  two  trian- 
gular pieces  of  cloth,  united  at  then"  base  on  the  summit  of  the  head, 
each  forming  a  kind  of  inverted  pocket,  with  which  the  ears  are 
covered.  It  is  secured  by  six  bands,  the  two  superior  having  loops 
through  which  the  middle  ones  pass,  these  crossing  each  other 
under  the  throat  and  extending  upward  to  be  tied  on  the  poll. 
The  lower  bands  cross  each  other  on  the  forehead  and  pass  imder 
the  head,  to  return  on  the  lower  part  of  the  face  where  they  arc 
secured.  Another  way  to  apply  a  dressing  on  the  ear  to  envel- 
ope it  properly  is  to  use  a  thin  bandage,  which,  after  it  has  envel- 
oped the  ear,  is  passed  around  the  head  on  each  side,  and  secured 
under  the  thi'oal  (ligy.  117,  118).     ^Vhen  supported  by  a  tightly 


BANDAGES. 


109 


Fig.  113.— Binocular  Band  (full  view). 


Fig.  114.— Binocular  Band  (side  view). 


Fig.  115.— Ear  Bandage  (full  view). 


Fig.  116.— Ear  Bandage  (side  view). 


fitting  halter  this  bandage  maintains  its  position  in  a  manner  quite 
satisfactory.  To  this  kind  of  bandage  can  be  added  the  one  used 
for  dogs  under  the  name  of  ca}^,  which  is  made  of  soft  cloth  or  fine 
cord  net.  The  caps  recommended  by  the  Germans  answer  the 
purpose  also  very  weU  (Figs.  120,  121). 

7th,  Bandage  for  the  Parotids  or  Throat. — This  bandage  is 
long  and  square,  and  is  notched  in  the  middle  of  the  two  borders 
to  secure  the  inferior  border  of  the  neck,  and  adapt  itself  to  the 
maxillary  space.     It  covers  the  parotid,  and  is  secured  by  four 


110 


SURGICAL    THERAPEUTICS. 


Fig.  118.— Bandage  for  the  Ears  (full  view). 


Fig.  1S2  —Parotids 


bands,  two  attached  in  front  of  the  forehead,  the  others  on  the 
poll.  This  bandage  is  often  combined  with  that  of  the  maxillary 
region,  and  made  in  a  single  piece  (Fig.  122). 

8th.  Bandage  for  the  Sujjerior  Border  of  the  JVeck. —  This 
bandage  is  a  long  jiiece  of  cloth  placed  upon  the  dorsal  border 
and  lateral  faces  of  the  neck,  with  a  prolongation  in  front,  passing 


Ill 


Fig,  119.— Bandage  for  the  Ear^,  A.    Bandage  for  the  Mammee,  B. 


*lflf-'?f 


.Iff I  "l 


Fig.  121. — German  Bandage  toi  the  Ears. 


Fig.  121.— Another  German  Bandage  for  the  Ears. 


112 


SURGICAL    THERAPEUTICS. 


Fig.  123.— Bandago  for  Superior  Border  of  the  Neck. 

between  the  ears  and  down  to  the  forehead.  Eight  bands  secure 
it.  The  two  inferior  bands  (h)  have  loops  through  which  the 
bands  pass  to  cross  each  other  under  the  maxillary  bones,  and 
extend  upward  on  each  side  of  the  head  to  be  tied  over  the  poll. 
The  bands  (d)  are  fixed  on  the  breast-band  of  a  Dutch  collar,  and 
(/')  is  attached  to  the  surcingle  (Fig.  123). 

9th.  Bandage  for  the  Anterior  and  Lateral  Parts  of  the 
Neck. — This  bandage  is  octagonal,  with  a  band  at  each  angle. 
The  anterior  are  tied  on  the  forehead  or  on  the  throat-strap  of  the 


Fig.  124.— Bandage  for  the  Anterior  and  Lateral  Parts  of  the  Neck. 


113 


halter,  the  middle  ones  over  the  dorsal  border  of  the  neck ;  the 
posterior  cross  each  other  over  the  withers,  and  are  secured  to  the 
siu'cingle,  as  are  also  the  two  lower  (Fig.  124). 

10th.  Bandage  for  the  Withers. — This  is  square,  truncated  at 
its  posterior  angles,  and  having  in  the  middle  of  its  anterior  and 
posterior  border  a  fold  to  adapt  it  to  the  height  of  the  withers. 
There  are  five  bands.     The  anterior  are  secured  forward,  above 


Fig.  125.— Bandage  for  the  Withers. 


the  breast,  the  posterior  are  passed  around  the  thorax  and  tied 
together,  the  other  sewed  on  the  middle  of  the  posterior  border 
extending  along  the  spine  and  attached  to  the  crupper. 


Fig.  126.— Bandage  for  the  Back. 


114 


SURGICAL    THEEAPEUTICS. 


11th.  Bandage  for  the  Back. —  This  bandage  is  composed 
of  a  long,  square  piece,  truncated  on  its  two  posterior  angles,  and 
has  six  bands,  one  at  each  angle.  The  two  in  front  are  tied  to- 
gether after  passing  around  the  chest,  the  middle  ones  after  sur- 
rounding the  abdomen  toward  the  umbilical  region  and  the  pos- 
terior are  united  after  forming  a  kind  of  crupper  in  passing  under 
the  tan  (Fig.  126). 

12th.  Bandage  for  the  Loins  and  Croup.  —  This  band- 
age is  of  a  form  similar  to  the  preceding,  and  of  sufficient  size  to 
cover  the  croup  posteriorly.  It  is  truncated  on  both  posterior 
angles,  and  each  border,  except  the  anterior,  has  folds  to  allow 
the  bands  to  adapt  itself  to  the  rotundity  of  the  region.     At  each 


Fia.  127.— Bandage  for  the  Loins  and  Croup. 

angle  is  a  band,  the  posterior  passing  around  the  abdomen,  and 
carried  backward  and  upward  to  be  tied  over  the  loins.  The  pos- 
terior then  turns  from  without  inwards,  over  the  round  of  the  hip, 
crossing  obHquely  the  internal  face  of  the  thigh  forward  to  the 
stifle,  and  passing  over  the  external  face  of  the  thigh  to  the  mid- 
dle bands  on  a  level  with  the  hip-joint,  where  they  are  tied.  Two 
extra  bands  may  be  attached  to  the  front  border  and  tied  to  the 
sm-cingle,  if  thought  necessary,  to  prevent  the  bandage  from  slip- 
ping backwards. 

13th.  Bandage  for  the  Hip  (Figs.  128, 129).— This  is  formed  of 
a  piece  of  cloth  the  length  exceeding  the  breadth  by  one-half,  or 
in  the  proportion  of  three  to  two,  and  so  enveloping  the  hip  and 
part  of  the  croup  that  the  inner  border  runs  along  the  peri- 
nseum,  and  the  outer  on  the  external  face  of  the  thigh  and  leg. 


115 


Fig.  128.— Bandage  for  the  Hip. 


Fig.  129.— The  same  separate. 


This  border  (/,  d)  forms  a  fold  about  four  inches  wide  at  its  base, 
and  the  inferior  {d,  e,  c)  has  two  which,  like  the  first,  form  an 
exact  adaptation  to  the  parts.  Eight  bands  belong  to  this  band- 
age— three  upon  the  posterior  border  (a,  a,  a)  at  its  superior  part, 
which  are  fixed  to  the  crupper,  the  superior  border  having  one 
(b)  long  enough  to  reach  to  the  surcingle,  and  the  inferior  border 
having  three  (d,  e,  c).  The  bands  d  and  e  pass  around  the  leg 
and  cross  each  other  at  g,  the  band  d  being  fixed  to  the 
crupper,  while  e  extends  to  the  surcingle  forward.  Band  e  crosses 
obhquely  to  the  inner  face  of  the  thigh,  passes  upward  along  the 


116 


SURGICAL    THERAPEUTICS. 


flank,  and  is  tied  to  the  surcingle.     The  band  /  is  fixed  ui^on  e,  as 
seen  in  the  illustration,  Fig.  128  at  h. 

14th.  Bandage  for  the  Inguinal  Region  and  Ferinceum. — 
This  is  applied  to  the  testicles  or  to  the  mammte.  It  is  a  long, 
triangular  bandage,  with  its  base  placed  forward,  and  is  provided 


Fig.  130. -Bandage  for  the  Inguinal 
Kegiou  and  Perineum. 


Fig.  131.— The  same  separate. 


with  four  bands,  one  at  each  angle  of  the  base.  These  are  passed 
around  the  flanks  to  be  fixed  on  the  loins,  the  two  posterior  on 
the  apex  of  the  triangle  to  draw  along  the  perineum,  and  passed 
over,  and  on  each  side  of  the  tail,  crossing  each  other  to  join  the 
first  one,  to  which  they  are  tied. 

15th.  Bandage  for  the  Abdotyien. — This  should  be  oblong  in 
shape,  its  length  double  its  breadth,  and  having  folds  on  each  of 
its  long  sides  to  adapt  it  to  the  convexity  of  the  body.  The  bands 
are  six  in  number,  two  of  which  are  fixed  on  the  loins,  two  on  the 
back,  and  two  over  the  withers.  A  seventh  is  sometimes  added, 
which  passes  around  the  base  of  the  neck  and  prevents  the  band- 
age from  slipping  backwards  (Fig.  132). 

16th.  Bandage  for  the  Chest. — This  is  square,  with  a  prolon- 
gation in  front  to  go  between  the  fore  legs,  and  which  is  notched 
on  the  front  to  adaj)t  itself  to  the  chest  behind  the  elbows.  The 
bands  are  six,  one  at  each  angle,  and  two  on  the  prolongation  in 
front.  These  are  fixed  in  pairs,  over  the  back,  the  loins  and  the 
withers  (Fig.  133). 


d 


Fig.  134.— Bandage  for  the  Breast. 


118 


SURGICAL    THEKAPEtTTICS. 


ITth.  Bandage  for  the  Breast. — This  resembles  the  preced- 
ing, except  that  the  narrow  prolongation  is  attached  under  the 
chest  to  the  surcingle,  or,  surrounding  the  forearm,  goes  to  the 
withers.  The  others  are  tied  over  the  withers  and  on  the  sides 
of  the  chest  to  the  surcingle  (Fig.  134). 

18th.  Bandage  for  the  Shoidder. — This  is  cut  in  the  form  of 
a  trapezium,  to  cover  the  shoulder  and  the  arm.  It  is  appHed  some- 
what obliquely,  and  has  on  its  front  borders  (Fig.  135)  folds  to 
adapt  it  to  the  convexity  of  the  anterior  part  of  the  arm.     Of  its 


Fig.  136.— Same,  ieolated. 


119 


seven  bands,  c,  c  are  fixed  on  the  withers  at  the  origin  of  the  neck, 
ef,  passing  first  around  the  forearm  and  joining  c  e,  as  it  passes 
on  the  opposite  side^  and  d,  g,  h  are  secured  to  the  surcingle. 

19th.  Bandage  for  the  Shoulder  Johit. — This  bandage  is 
square  and  truncated  on  its  superior  angle,  and  is  provided  with 
several  folds  to  adapt  it  to  the  convexity  of  the  shoulder.     The 


Fig.  137.— Bandage  for  the  Shoulder  Joint  Proper. 

bands  are  six,  three  anterior  and  three  posterior.  The  first  two 
are  apj)lied  around  the  neck,  the  third  on  a  ring  at  the  surcingle  ; 
the  other  three  also  going  to  the  surcingle,  either  directly  or  in 
passing  around  the  inside  of  the  forearm. 

20th.  Bandage  for    the    Elhov). — This  bandage  is   of   an  ir- 
regular shape,  with  folds  on  its  lateral  and  lower  borders,  to  adapt 


Tig.  138.— Bandage  for  the  Elbow. 


120 


SURGICAL    THEKAPEUTICS. 


Fig.  139.— Same,  isolated. 

it  accurately  to  the  point  of  the  elbow.  Five  bands  serve  to  con- 
fine it,  /  going  directly  to  the  withers  where  it  is  tied  with  i,  j)re- 
viously  passed  under  and  around  the  thorax  on  the  opposite  side, 
g  and  h  are  secured  to  the  breast-band  of  a  Dutch  coUar,  k  passes 
around  the  forearm  on  the  inside,  from  behind  forward,  and 
passes  in  front  of  the  breast  to  be  also  seciu-ed  to  the  Dutch  collar. 
21st.  Bandage  for  the  Forearm. — This  is  of  an  irregular  tri- 
angular sharp,  with  the  apex  truncated,  and  the  base  notched  to 
accommodate  itself  to  the  axilla  and  the  fold  of  the  elbow.  When 
appHed,  the  apex  of  the  triangular,  which  forms  a  short  border, 
is  turned  downward  and  the  base  upward  in  the  axilla.  Two 
bands  sewed  to  each  angle  of  the  base  are  fixed  to  the  breast-band 


Fig.  140.— Bandage  for  the  Forearm. 


BANDAGES. 


121 


of  the  Dutch  collar,  and  the  borders  are  secured  b}'  little  tapes  on 
the  outside  of  the  forearm.  Sometimes  these  borders  are  fastened 
together  by  laces  inserted  obHquelj. 

22d.  Bandage  for  the  Knee. — This  is  square,  notched  on  its 
superior  border  and  in  the  center,  both  of  which  are  provided  with 
a  small  piece  to  form  a  gusset,  in  which  the  bony  projections  of 
the  knee  are  secured.  A  double,  ordinary  band,  or,  what  is  better, 
an  elastic  strap  attaches  it  to  the  breast-band,  while  smaller  tapes 
serve  to  tie  it  to  the  back  of  the  knee. 


Fig.  141.— Bandage  for  the  Knee. 


Fig.  148.— Bandage  for  the  Stifle. 


23d.  Bandage  for  the  Stifle. — This  is  of  a  triangular  figure, 
the  base  of  which  shordd  be  four  times  longer  than  its  height.  It 
has  three  bands,  one  at  each  angle.  That  of  the  superior  angle 
i:)asseB  along  the  flank,  and  is  attached  to  the  crupper  straj)  at  the 
loins ;  that  of  the  inferior  angle  twists  forward  and  inward  on  the 
thigh,  and  connects  with  the  cruj)i3er  at  the  base  of  the  tail,  while 
the  third  band  turns  around  the  cruj^per,  crosses  the  internal  face 
of  the  thigh  from  behind  forward,  passes  in  front  of  the  stifle,  and 
terminates  backward  at  the  same  point  with  the  preceding  band, 
after  twisting  around  that  of  the  superior  angle. 


122 


SURGICAL    THEKAPEI/TICS. 


24tli.  Leg  Bandage. — This  is  the  comjDhcated  device  repre- 
sented in  Figs.  143  and  144.  It  has  four  bands  on  its  superior 
border,  (Fig.  144  «,  5,  c,  d)  and  the  lateral  borders  have  five  or 
six   tapes.      The   bandage   has  three  gussets,  two  of   which,   c 


Fig.  143 — Bandage  for  the  Leg  Applied. 

and  ^,  are  on  the  superior  border,  and  one,  ^,  on  the  inferior,  and 
the  two  lateral  borders  have  each  one  a  fold.  To  put  the  bandage 
in  place,  the  band  d  is  passed  along  the  flank  upward  and  tied  to 
the  crupper  strap,  c,  j)assing  from  within  outward  on  the  inside 


Fig.  144.— The  same,  isolated. 


123 


of  the  thigh,  to  be  fixed  on  the  round  of  the  crupper.  A  and  b 
cross  each  other  at  the  lower  part  of  the  leg,  a  little  above  the 
tendo-Achilles,  in  order  to  allow  a  to  pass  from  the  inside  to  the 
outside  of  the  leg  so  as  to  become  attached  to  the  surcingle, 
while  b  is  secured  to  the  round  of  the  crupper.  The  small  taj)es 
are,  of  course,  tied  together  in  couples. 

25th.  J^andage  for  the  Hock  and  Gannon.  —  This  requires  a 
piece  of  cloth  of  sujBficient  dimensions  to  completely  surround  the 
hock  and  cannon  down  to  the  fetlock.     Its  superior  border  is 


Fig.  145.— Bandage  for  the  Hock 
and  Cannon,  applied. 


Fig.  146.— The  same,  isolated. 


notched  for  the  fold  of  the  hock,  and  a  gusset  is  made  in  its  lower 
extremity  for  the  fetlock.  Four  straps  proceed  from  its  superior 
border  to  be  secured  to  the  bandage  of  the  leg,  and  the  ends  of 
the  small  tapes  of  its  lateral  borders  are  tied  together  in  pairs  in 
front  of  the  leg. 

{(j)  Mechanical  Bandages. — This  is  the  distinctive  name  of  a 
class  of  dressings  which  are  not  only  a  passive  means  of  protec- 
tion to  the  parts  upon  which  they  are  appHed,  but  from  which 
also  proceeds  a  direct  or  positive  action,  by  co-operating  in  the 
recovery  of  lesions,  if  indeed  it  is  not  the  true  operating 
cause  which  brings  it  about.     Eollers  and  wide  bandages  some- 


124  SURGICAL    THERAPEUTICS. 

times  act  as  meclianical  bandages.  But  the  name  is  more  par- 
ticularly applicable  to  certain  more  or  less  complicated  apparatus- 
es, whose  special  mechanical  action  has  the  effect  of  producing 
some  defined  therapeutical  result.  The  metallic  plate  used  in  the 
reduction  of  some  forms  of  hernia;  the  metallic  spring  apparatus 
used  in  applying  pressure  upon  special  regions,  as,  in  orthopedic 
surgery,  or  in  the  reduction  of  fractures  or  dislocations,  lite  those 
invented  by  Bourgelat,  Brogniez,  Defays,  and  others,  are  of  this 
class,  inasmuch  as  all  of  these  possess  the  constituent  properties 
which  are  understood  to  characterize  the  agencies  belonging  to 
the  category  of  mechanical  bandages. 

These  will  be  subjects  for  our  consideration  when  we  treat  of 
the  various  conditions  in  which  they  are  indicated. 


CHAPTER  IV. 
ELEMENTARY  OPERATIONS. 

Under  this  term  are  understood  those  of  a  simple  nature,  as 
perhaps  an  incision  or  puncture,  or  the  insertion  of  sutures,  and 
other  implicated  manipulations,  but  which  form  the  foundation 
and  belong  to  the  operative  generalities  of  the  domain  of  major 
surgery.  They  will  be  treated  under  the  two  principal  heads  of 
division  or  dieresis,  and  reunion  or  synthesis. 

DIVISION. 

This  is  a  very  common  sui-gical  step,  of  which  the  object  is 
the  separation  of  tissues  from  each  other.  Gourdon  has  recog- 
nized six  principal  modes  by  which  to  divide  tissues,  viz.:  by  in- 
cision, dissection,  puncture,  resection,  ligature  and  cauterization. 
Varying,  somewhat,  from  this  view,  and  considering  resection  as 
an  operation  specially  appropriate  to  bony  structures,  and  liga- 
ture as  adapted  to  the  cellular  tissues,  and  classifying  cauteriza- 
tion as  i)rincipally  a  means  of  puncture,  we  prefer,  with  Peuch 
and  Toussaint,  to  reduce  the  consideration  of  these  modes  of 
division  to  three,  ^dz.:  incision,  dissection  and  puncture. 

A. — Incisions. 
Any  methodic  division  of  soft  tissues  made  with  a  sharp 
instrument  is  an  incision.  The  basis  of  the  majority  of  surgical 
operations,  their  purpose  is  to  allow  the  escape  of  the  contained 
fluid  from  a  cavity,  to  enlarge  the  -size  of  a  wound,  to  make 
counter  openings,  to  extract  foreign  bodies,  to  remove  pathologi- 
cal growths,  to  destroy  abnormal  adhesions,  to  expose  tissues  to 
be  operated  upon  or  tumors  to  be  removed,  to  facilitate  the  re- 
duction of  displaced  organs,  etc.,  etc.  The  bistoury,  the  scalpel, 
the  sage  knife  and  the  scissors  are  the  cutting  instruments  most 
commonly  used  for  making  incisions.  Sometimes,  however,  the 
amputation  knife,  the  tenotome,  the  hemiotome,  with  lancets,  or 


126  ELEMENTAKT    OPERATIONS. 

even  drawing  knives,  take  their  2)lace.  Drawing  knives,  however, 
are  better  ada2)ted  to  excise  the  horny,  or  other  similar  hard  struc- 
tures, than  to  cut  upon  soft  tissues. 


Fig.  147.— Straight  Bistoviry. 


Fig.  148.— Convex  Bistoury. 


Fig.  149.— Concave  Bistoury. 


Fig.  150.— Blunt  Bistoury. 


Fig.  151.— Bistoury  Cach6  (Castrating  Knife  for  Females). 

In  form,  the  bistoury  is  either  straight,  convex  or  concave, 
and  usually  is  i:)ointed,  but  the  use  of  blunt  or  guarded  instru- 
ments is  often  indicated.  The  bistoury  cache  is  also  employed  in 
some  special  operations.  A  bistoury  is  generally  mounted  with 
a  single  blade,  though  sometimes  several  blades  are  mounted 
together  on  one  handle,  and  can  be  closed  upon  it  in  the 
manner  of  an  ordinary  pocket  knife.     But  when  strict  antiseptic 


127 


rules  are  observed  in  the  operations,  the  blade  is  held  firmly  on 
the  handle,  and  cannot  be  closed. 

Sage  knives,  which  are  much  used  in  operations  upon  the  foot, 
are  but  convex  bistouries,  single  or  double,  curved  upon  their 
length,  and,  according  to  the  disposition  of  the  cutting  edge,  are 
called  right,  or  left,  or  double.     The  blade  is  generally  firmly 


Fig.  152.— Right,  Left  and  Double  Sage  Knives. 

riveted  in  the  handle,  to  render  it  more  soHd  and  better  adapted 
to  the  incision  of  the  comparatively  harder  tissues.  When  made 
to  close  as  an  ordinary  pocket  knife  they  are  less  solid,  and  more 
difficult  to  keep  in  good  condition. 

The  scissors  vary  also  in  shajie,  and  are  sometimes  straight, 
sometimes  curved,  and  with  either  blunt  or  pointed  ends.  Be- 
sides these  cutting  instruments,  directors  are  often  used  as  guides 
to  carry  the  knife  in  the  desired  direction,  and  obviate  errors 
and  accidents  in  operating.     The  bistomy   is  held  in   different 


128 


ELEMENTAKY    OPERATIONS. 


-Various  Shapes  of  Scissors. 

positions,  according  to  circumstances,  as  we  shall  proceed  to  point 
out  and  classify. 

1st.  Held  as  a  writing  pen. — That  is,  with  the  handle  resting 
on  the  back  of  the  hand,  the  thumb,  index  and  medius  finger  on 
each  side  of  the  blade,  the  other  two  fingers  restiug  on  the  skin. 


--^i 


Figs.  154  and  155.— Bistoury  held  as  a  Writing  Pen. 

In  this  position  the  edge  of  the  blade  may  be  tui-ned  either  down- 
ward or  upward.  The  di\dsion  mentioned  by  Gourdon,  with  the 
fingers  extended  or  flexed  upon  the  blade  is  scarcely,  and  at  best 
but  a  variety. 

2d.  The  instrument  may  be  held  as  the  bow  of  a  violin,  or 
the  thumb  on  one  side  of  the  articulation  of  the  blade,  with  the 
handle  and  all  the  fingers  on  the  opposite  side,  the  index  on  the 
back  of  the  blade,  the  medius  on  the  articulation  opposite  the 
thumb  and  the  other  two  fingers  on  the  side  of  the  handle. 
None  of  the  fingers  must  be  allowed  to  divert  the  instrument  from 
being  carried  horizontally  upon  the  tissues.  In  this  joosition  the 
edge  of  the  blade  may  be  turned  either  downward  or  upward. 


120 


Pigs.  156, 157, 157a.— Bistoury  held  as  a  Bow  of  a  Violin. 

3d.  The  bistomy  can  be  held  as  a  table  knife.  The  thumb 
and  the  medius  being  placed  on  opposite  sides,  at  the  junction  of 
the  blade  and  the  handle,  the  index  resting  upon  the  back  of  the 


Figs.  158,  159.— Bistoury  held  as  a  Table  Knife 

blade,  the  other  fingers  holding  the  handle  in  the  hollow  of  the 
hand.  As  in  the  i:)receding  positions,  the  edges  of  the  blade  may 
be  either  turned  downward  or  upward. 

Whatever  position  may  be  given  to  the  instrument,  it  is  to  be 
held  firmly,  and  with  a  steady  hand.  Sage  knives  are  generally 
held  by  grasping  the  handle  full  in  the  hand,  or,  as  when  holding 
a  bistomy  as  a  table  knife,  sometimes  with  one  hand  only,  and  at 
others  with  both,  according  to  the  indications  and  the  amount  of 
firmness  and  steadiness  required.  The  manner  of  holding 
scissors  is  already  known.     The  only  variation  likely  to  be  found 


130 


ELEMENTARY   OPERATIONS. 


Fig.  160.— Sage  Knife  held  with  One  Hand, 


Fig.  161.— Sage  Knife  held  with  Two  Hands. 

needful,  is  that  in  some  cases  it  is  laandier  to  grasp  them  from 
above  and  in  others  from  below. 

There  are  some  general  rules  which  are  important  to  observe 
in  performing  the  simplest  operation.  These  I'elate  to  the  condi- 
tion of  the  instrument,  to  the  preparation  of  the  jDarts,  and  to  the 
direction  and  dimensions  of  the  incision. 

The  condition  of  the  instrument  must  be  such  that  the  soft 
tissues  may  be  divided  with  but  Httle  pressure.  It  must  cut  and 
not  tear.  Therefore,  besides  their  state  of  thorough  cleanliness, 
they  must  be  very  sharji  and  then*  edge  entirely  smooth  and  free 
of  indentation,  which  would  cause  them  to  act  as  a  saw  and  pro- 
duce an  iiTegular  and  ragged  incision,  more  painful  to  the  patient, 
and  more  difficult  to  heal.  It  has  been  recommended  to  dip  them 
before  using  in  oil  or  warm  water,  but  these  precautions  can  be 
dispensed  with. 

The  region  upon  which  the  incision  is  to  be  made  must  be 
thoroughly  cleaned,  the  hairs  being  clipped  short,  and  sometimes 
even  shaved.  In  these  days  of  antisej)sy,  it  is  proper  to  soak  it 
well,  after  it  is  washed,  with  some  antiseptic  solution.  To  make  a 
clean  incision,  the  skin  must  be  weU  stretched  with  the  hands,  the 
instrument  fii-mly  held,  and  the  division  made  by  a  steady  move- 


INCISIONS.  131 

ment,  to  avoid  the  possibility  of  extending  the  iacision  beyond  the 
necessary  limits. 

The  dii-ection  and  size  of  incisions  require  careful  consider- 
ation. They  must  run  as  nearly  parallel  with  the  direction  of  the 
muscular  fibres  and  the  large  blood  vessels  and  nerves  of  the 
region  as  the  condition  of  the  part  will  permit. 

Their  direction  should  also  correspond  to  that  of  the  long 
axis  of  the  part  or  tumor  undergoing  operation,  and  ia  such  a 
manner  that  the  retraction  of  the  skin  will  not  tend  to  separate 
the  borders  of  the  wound.  Sometimes,  according  to  the  unavoid- 
able natural  motions  occm-ring  in  a  region,  the  normal  folds  of 
the  skin  should  be  considered.  A  vertical  incision  is  always  pre- 
ferable, as  more  readily  allowing  the  escape  of  liquids,  pus  or 
otherwise,  which  may  have  accumulated. 

As  much  as  possible,  and  generally,  incisions  should  be  made 
with  a  single  stroke,  and  of  the  f  uU  length  and  depth  requked  by 
the  fui'ther  steps  of  the  operation.  Besides  diminishing  the  suf- 
fering of  the  animal,  such  an  incision  will  greatly  facHitate  aU 
the  subsequent  manipulations  of  the  operator. 

Incisions  are  made  by  four  principal  methods :  first  from 
without  inwards;  second,  from  within  outwards;  thu-d  by  sub- 
cutaneous division;  and  fourth  by  the  sHcing,  scraping  or  shaving 
method.  In  the  first  two  modes  the  instrument  may  be  tm-ned 
in  five  directions. 

(a)  Towards  the  operator,  by  beginning  at  the  farthest  point 
aud  moving  the  instrument  in  the  direction  of  his  own  person. 

(b)  From  the  operator,  by  reversing  the  former  movement. 

(c)  From  left  to  right  and  transversely,  the  instrument  being 
held  with  the  right  hand. 

{d)  From  right  to  left,  or  in  the  opposite  direction,  vsdth  the 
instrument  in  the  left  hand. 

(e)  From  above  downwards,  in  a  vertical  or  sHghtly  oblique 
direction. 

Incisions  from  left  to  right  and  from  above  downwards  are  the 
most  convenient,  and  for  this  reason  the  surgeon  practices  them 
as  much  as  possible. 

1st.  Incisions  from  without  inioards. — These  incisions  are 
carried  from  the  surface  of  the  skin  towards  the  deep  structures 
underneath.  They  may  be  made  with  any  kind  of  bistoury,  but 
the  convex  is  to  be  preferred. 


132  ELEMENTARY    OPERATIONS. 

The  skin  should  be  well  stretched  by  various  movements  of 
the  hand,  or  of  the  operator,  or  his  assistants,  and  held 
tense  and  smooth,  unless  it  is  already  sufficiently  expanded 
by  the  effect  of  the  existing  lesion  underneath  it.  Then  the 
operator,  holding  the  instrument  in  the  first  or  thiixl  position, 
carries  the  instrument,  with  the  edges  and  the  point  turned  down- 
ward, to  the  spot  on  the  surface  to  be  divided,  and  penetrating 
through  the  skin  to  the  depth  desired,  completes  the  incision  to 
its  proper  length. 

This  mode  of  incising  the  skin  answers  for  the  majority  of 
cases,  but  there  are  others  when  the  skin  has  to  be  divided  care- 
fully and  by  layers.  Incisions  are  then  made  with  the  convex 
bistoury,  held  in  either  position  with  its  edge  downward,  carried 
perpendicularly  over  the  skin  and  often  by  repeated  light  strokes. 

These  two  procedui-es  answer  when  the  j^art  to  be  operated 
upon  offers  a  certain  sohdity.  Otherwise  the  incision  can  be 
made  in  a  third  manner,  viz.:  by  taking  hold  of  a  fold  of  the  skin, 
held  at  one  end  by  an  assistant,  at  the  other  by  the  operator,  and 
completing  it  by  a  transverse  section  thi-ough  the  fold,  made 
from  the  apex  to  the  base.  The  objection  to  this  mode  of  dividing 
is  that  the  incision  can  never  be  thoroughly  limited. 

2d.  Incisions  from  within  outwards. — In  contrast  with  those 
ah'eady  considered,  these  incisions  are  made  from  the  deep  jiarts 
toward  the  superficial,  and  through  the  thickness  of  the  skin. 

The  Straight  Bistoury  is  here  the  j^referable  instrument,  either 
alone  or  assisted  by  a  guide  or  conductor,  which  may  be  the  grooved 
probe,  the  dii-ector,  or  the  finger  of  the  surgeon.  Either  with 
or  without,  these  incisions  can  be  executed  in  various  ways. 

Without  the  Director. — With  the  bistoury  held  as  a  writing 
pen,  with  the  blade  turned  upward,  first  the  point  of  the  instru- 
ment, and  then  the  entire  blade  is  thrust  perpendiciilarly  through 
the  tissues ;  then  lowering  the  handle  of  the  instrument  until  it 
forms  with  the  skin  an  angle  of  forty-five  degrees,  the  instru- 
ment is  moved  in  an  obhque  direction  in  such  a  way  as  to  stretch 
and  di^ide  the  skin,  until  at  the  end  of  the  incision  the  bistoury  is 
brought  back  to  a  perpendicular  direction  to  complete  the  incis- 
ion in  a  neat  manner.  This  incision  can  be  made  toward  or  from 
the  operator,  according  to  the  case.  It  will  facilitate  the  action 
of  the  instrument  if  the  skin  back  of  the  hand  that  holds  it  is 
stretched  with  the  free  hand  of  the  operator. 


INCISIONS.  133 

Another  manner  of  incision  from  within  outward  is  to  make  a 
fold  of  the  skin,  as  ah-eady  described,  and  by  pushing  the  straight 
bistoury  through  its  base,  and  turning  the  edge,  completing  it  by 
a  single  stroke  upward  to  the  summit.  When  an  incision  ah*eady 
existing  must  be  enlarged,  the  bistoury,  held  in  the  second  posi- 
tion, is  introduced  flatwise  under  the  skin  as  far  as  is  necessary ; 
then  turned  to  bring  the  edge  upward  and  pushing  the  point 
through  the  skin  by  drawing  the  instrument  outward,  the  flap  of 
sMn  between  the  two  openings  is  di\dded  at  one  stroke. 

A  fourth  procedure  is  known  as  the  incision  with  flaps.  It  is 
principally  used  in  amputations.  With  the  left  hand  the  surgeon 
grasps  a  fold  of  skin,  pushes  the  bistoury  held  in  the  first  position, 
but  flatwise,  through  its  base,  and  in  drawing  it  out  obhquely 
by  a  sawing  motion  cuts  out  a  semi-circular  flap  of  the  required 
dimensions. 

With  the  Director  or  Guide. — Incisions  in  this  mode  are  made 
to  remove  compressions  caused  by  strictures,  or  to  estabhsh  a  free 
exist  to  pus  by  a  counter  opening.  Either  the  finger  or  the 
grooved  probe  or  the  director  may  be  used  as  a  guide  to  the  in- 
strument. In  all  cases  there  must  already  exist  a  natural  or  acci- 
dental opening  to  allow  the  introduction  of  the  director.  Several 
modes  of  procedui-e  are  employed  according  to  conditions  and  ob- 
jects in  view.  In  one,  the  director  being  introduced  into  the  tract 
to  be  enlarged,  as  far  as  the  point  where  the  incision  must  end, 
the  bistoury,  held  in  the  first  or  second  position,  with  the  edge 
turned  upward,  is  made  to  slide  into  the  groove  of  the  director, 
forming  with  it  an  acute  angle,  and  pushed  in  its  whole  length, 
dividing  the  tissues  until  it  reaches  the  end  of  the  groove,  when 
it  is  withdrawn  in  the  perpendicular  position.  A  second  mode 
is  to  carry  the  bistoury  flatwise  alongside  the  director,  and  when 
reaching  its  end  to  turn  the  instrument  with  the  edge  upward, 
first  thrusting  the  point  through  the  tissues  and  tegument,  and 
completing  the  incision  by  withdrawing  the  bistoury  outward  and 
toward  the  operator.  In  a  third  procedvire,  which  is  that  of  mak- 
ing .counter  openings,  the  probe  or  director  is  introduced  into  the 
wound,  and  at  its  deej)  end,  to  push  toward  the  skin  until  it  raises 
it  from  the  inside  or  can  be  felt  through  it ;  an  incision  from  with- 
out inward  is  then  made  at  that  point,  and  the  director  being  ex- 
posed, the  bistoury  is  engaged  in  its  groove  and  pushed  alongside, 
dividing  the  tissues  at  wiU  in  length  and  in  depth,  and  establishing 


134  ELEMENTARY    OPERATIONS. 

a  broad  communication  between  the  original  opening  and  the  one 
just  formed.  By  using  the  sharjD  end  of  an  S  probe,  passing  it 
alongside  the  director  previously  engaged,  and  pushing  it  through 
the  side,  the  making  of  the  incision  from  without  inward  may  be 
avoided,  as  described  above,  and  the  groove  of  the  S  probe  may  be 
used  as  that  of  an  ordinary  director. 

Sometimes,  however,  when  the  original  opening  allows  it,  the 
finger  is  introduced  into  it  and  used  as  a  conductor.  In  this  case, 
a  blunt  bistoury  is  preferable,  as  less  dangerous  to  the  operator 
than  the  straight  instrument,  or  the  curved  form  may  be  used. 
This  may  be  made  to  slide  with  the  back  of  its  blade,  or  again 
flatwise,  along  the  palmar  face  of  the  finger  until  the  bottom  of 
the  wound  has  been  reached,  and  then  turning  the  knife,  the  tis- 
sues are  divided  by  carrying  the  bistoury  either  toward  or  from 


Fig.  162.— Using  the  Finger  as  a  Director. 

the  operator.  This  procedure  is  more  appHcable  when  the  fistu- 
lous head  is  not  deep,  but  it  is  jDreferable  to  the  use  of  the  ordin- 
ary director  as  being  a  much  better  instrument  of  diagnosis,  and 
safer  as  a  director  of  the  bistoury. 

3d.  Subcutaneous  Incisions. — The  usefulness  of  this  mode  of 
dividing  tissues  is  best  demonstrated  by  its  appUcation  to  cases 
of  tenotomy  and  myotomy,  or  the  puncture  preceding  the  injec- 
tion of  tincture  of  iodine  according  to  some  methods.  It  requii'es 
special  instruments,  made  with  narrow  blades  or  with  fine  trocars, 
which,  when  introduced  through  the  skin,  leave  a  very  small  open- 
ing, the  division  being  made  under  the  ligaments,  with  special  care 
to  avoid  its  division  beyond  the  point  where  the  instrument  has 
been  introduced.  Suppuration  seldom  follows  this  operation  if  it 
has  been  properly  performed,  and,  accordingly,  the  cicatrization  is 
very  rapid ;  the  great  advantage  obtained  by  this  mode  of  incision 
cannot  be  overlooked. 


INCISIONS.  135 

4tli.  Incisio7is  by  Slices — Scraping  or  Shaving  Incisions. — 
These  incisions  are  made  by  dividing  the  tissues  in  successive  lay- 
ers. Three  varieties  of  operation  are  practiced,  differing  accord- 
ing to  the  density  of  the  tissues  acted  upon.  In  the  first,  which  is 
apphcable  to  hard  structures,  the  bistoury,  or,  preferably,  the  sage 
knife  is  required.  The  instrument  is  held  full  in  the  hand,  as  a 
table  knife,  or,  again,  as  the  bow  of  a  violin,  and  is  passed  flatwise 
over  the  sm-face  of  the  tissues,  and  layers  of  various  thicknesses 
removed  from  it ;  and  sometimes  the  tissues  are  sufficiently  hard 
to  requii-e  the  strength  of  both  hands  for  the  management  of  the 
instrument. 


Fig.  163.— Sharp  Tenaculum. 

In  a  second  mode,  applicable  to  soft  tissues,  a  convex  bistouiy 
and  a  paii'  of  forceps  or  a  sharp  tenaculum  are  necessary.  Rais- 
ing with  either  of  these  a  thin  layer  of  the  tissue  to  be  divided, 
the  bistoury  is  carried  sUghtly  flatwise  over  the  siu'face  and  a  piece 
of  it  is  cut,  scraped,  or  shaved  ofl",  the  operation  being  repeated 
until  the  desired  depth  has  been  reached. 

A  third  mode  is  applied  in  cases  of  growths  which  are  to  be 
cut  off  at  their  base.  To  do  this,  the  growth  is  raised  as  much  as 
possible,  by  means  of  the  forceps  or  tenaculum,  and  the  amputation 
is  accompHshed  with  a  few  sawing  movements  of  the  instrument. 

The  forms  which  incisions  may  receive  are  of  two  principal 
kinds — the  simple  and  the  cornpound. 

Simple  incisions  are  those  which  are  generally  made  with  one 
stroke  of  the  bistoury,  and  generally  from  without  inward, 
and  are  either  straight  or  curved.  The  straight,  or  simple,  are 
indicated  for  the  exposure  of  regions,  the  oj)ening  of  abscesses, 
etc.,  etc'  They  are  not  as  applicable  to  the  removal  of  tumors, 
especially  of  those  which  have  large  bases.  The  curved  incisions 
vary  in  their  circular  shape,  and  diiier  also  from  the  straight  in 
the  modus  operandi,  as  they  require  a  stretching  of  the  skin  to 
be  made  in  various  directions,  as  that  of  the  bistouiy  is  changed 
over  the  cutaneous  surface. 

Compound  incisions  are  formed  by  the  union  of  several  simj)le 
incisions,  their  number  varying  much,  but  they  may  be  reduced 


136  ELEMENTAKY    OPERATIONS. 

to  the  following  kinds:  the  T  and  V  shaped,  the  crucial,  the 
elliptic,  and  the  semi-lunar.  The  branches  of  these  compound  in- 
cisions are  made  in  the  same  manner  as  for  the  simple  kind ;  when 
two  incisions  are  to  meet  at  a  given  point,  the  second  one  must  be 
made,  not  to  begin,  but  to  terminate  at  that  point ;  when  two 
incisions  are  to  unite,  one  above  the  other,  the  lower  one  is  to  be 
made  first,  to  avoid  the  flow  of  blood  from  the  upper,  which  would 
cover  and  conceal  it ;  and  when  two  incisions  are  to  meet  at  their 
extremities,  it  is  proper  that  the  ends  of  the  second  incision  should 
start  a  short  distance  beyond  the  commencing  point  of  the  first, 
and  terminate  with  a  similar  space  from  the  end  of  the  first  in- 
cision. In  other  words,  the  junction  of  the  extremities  of  the  two 
incisions  must  never  be  by  a  perfect  acute  angle.  The  angle  must 
always  have  a  shght  prolongation  formed  at  one  extremity,  by  the 
extension  of  one,  and  at  the  other  by  that  of  the  other  incision. 
These  rules  are  not  absolute,  but  may  be  changed  as  circumstances 
may  require. 

In  the  T-shajyed  incision,  a  straight  cut  is  carried  j)erpendicu- 
larly  upon  the  middle  of  another.  In  the  V-shaped,  there  are 
two  straight  incisions  meeting  at  an  acute  angle  by  one  of  their 
extremities,  this  angle,  as  we  have  just  said,  having  a  small  pro- 
longation on  one  of  its  lines  at  their  junction.  The  V-shaped  in- 
cision may  open  in  every  dii'ection.  Sometimes  the  two  incisions 
are  made  to  meet  at  a  right  angle,  to  form  the  L-shaped  incision. 

In  the  crucial  incision,  two  straight  cuts  are  made  to  meet  at 
their  middle,  usually  at  a  right,  sometimes  at  an  acute  angle, 
forming  an  X-shaped  incision.  This  is  made  in  three  stejDs,  first, 
a  simple  straight  cut ;  second,  the  first  part  of  the  second  incision 
as  in  the  T-shaped  form,  and  third,  the  second  part  of  the  second 
incision  ending,  not  beginning,  at  the  point  of  junction  of  the  in- 
cision made  in  the  first  two  stejDS,  and  in  such  a  manner  as  to  be 
the  continuation  of  the  incision  made  on  the  second  step.  This 
incision  may  also  be  made  in  two  cuts,  when  the  skin  is  hard  and 
adherent  to  the  deeper  tissues,  by  making  the  second  incision 
with  one  stroke  of  the  knife,  passing  at  the  middle  of  the  first. 

The  elliptic  incision  is  made  with  two  curved  cuts,  so  united  at 
their  extremities  as  to  leave  between  them  an  elliptical  space.  The 
semi  lunar  or  crescentic  incision  is  formed  by  two  cui'ved  ones, 
the  circumferences  of  which  are  turned  in  the  same  dii-ection, 
lea^^-nf]f  between  them  a  form  like  that  of  the  new  moon. 


137 


Fig.  164 T-Bhape  Incision. 


Fig.  165.— V-8hape  Incision. 


Fig.  166.— Crucial  Incision. 


-Semi-Lunar  Incision. 


Fig.  168.— L-shape  Incision. 


-X-shape  Incision. 


Fig.  170.— Elliptic  Incision. 


B. — Dissections. 

Dissection  is  the  separation  of  the  cellular  tissue  from  the 
various  parts  to  which  it  is  united.  The  scalpel,  the  bistoury 
and  the  scissors  are  among  the  necessary  instruments,  sometimes 
replaced  or  assisted  by  the  fingers  or  a  strong  director.  With  the 
scalpel,  or  the  bistoury,  the  handle  is  also  utilized,  and  frequently 
the  blunt  extremity  of  the  scissors,  while  again  in  some  cases  the 
cellular  connections  are  separated  with  the  fingers  or  the  blunt 
end  of  a  director.  To  these  instruments  are  added  forceps,  either 
the  common  dissecting,  or  the  bull-dog  form.  Three  procedures 
are  involved,  viz.:  the  free  dissection,  the  limited,  and  the  dissec- 
tion by  slices  or  shavings. 


138 


ELEMENTARY    OPERATIONS. 


Fig.  172.— Bull-Dog  Forceps. 

(a)  Free  dissection  is  tliat  of  a  flap  of  skin  from  the  tissues 
beneath,  to  which  it  is  only  slightly  adherent.  Holding  the  skin 
with  the  fingers,  or  the  forceps,  with  one  hand,  and  ha\ing  the 
bistoury  or  scalpel  in  the  other,  the  skin  is  raised  as  much  as 
possible  and  separated  from  the  other  tissues  with  a  single  stroke 
of  the  bistoury,  held  as  a  pen  or  as  a  violin  bow,  the  operator 
drawing  it  towards  him  as  much  as  possible.  In  the  dissections 
of  flaps  of  skin,  as  those  in  theV,  the  T,  the  crucial,  and  the  cres- 
centic  incisions,  the  strokes  of  the  bistoury  extend  in  length  as 
they  approach  the  base,  or  the  adherent  portion  of  the  cutaneous 
flap.  In  the  straight  or  elliptic  incisions,  on  the  contrary,  the 
strokes  are  longer  at  the  beginning.  When  the  cellular  tissue  is 
very  loose,  its  separation  from  the  skin  is  made  with  the  fingers 
or  the  blunt  end  of  the  scissors.  This  mode,  called  enucleation, 
is  often  employed  for  some  special  forms  of  tumors,  as  the 
fibroid,  or  fatty. 

(b)  Limited  Dissection. — The  steps  of  this  process  are  the  same 
as  those  of  the  preceding,  excepting  that  the  surgeon  proceeds 
by  small  strokes  in  order  to  avoid  going  too  deeply  into  the 
tissues,  and  leave  the  skin  of  a  sufiicient  thickness. 

(c)  Dissection  by  Slices  or  Shavings. — The  skin  being  di-^dded, 
and  the  subcutaneous  tissues  raised  with  the  forceps,  the  bistomy, 
held  flatwise,  excises  horizontally  each  la^'er  of  the  structure  by 
a  sawing  movement. 

C. — Puncture. 

Properly  speaking,  this  is  a  simple,  special  operation,  designed 
to  penetrate  into  hollow  parts,  to  explore  the  nature  of  tumors,  to 


DISSECTIONS. 


139 


examine  the  contents  of  natm-al  ca\ities,  or  to  pro%ide  for  the  escape 
of  gases  or  fluids.  It  is,  therefore,  a  solution  of  continuity  of 
small  dimensions,  constituting  often  the  first  steps  of  an  incision, 
but  which  forms  also  an  essential  operation.  It  can  be  performed 
with  various  instruments,  as  the  lancet,  the  straight  bistoury,  the 
trocar,  the  exploring  needle  and  then-  adjuncts,  the  asjjirator,  and 
the  actual  cautery. 


Fig.  173.— Various  Shapes  of  Lancets. 

Puncture  with  the  Lancet. — In  form  and  shape  the  lancet 
greatly  varies,  but  in  general  it  may  be  considered  as  a  compound 
bistomy,  with  a  poiated  and  two-edged  blade.  The  point  may  be 
either  quite  wide,  or  very  acute,  and  is  sometimes  curved,  with  one 
edge  convex  and  the  other  concave. 

To  use  the  lancet,  the  bladfe,  open  at  a  right  angle  wdth  its 
handle,  is  held  between  the  thumb  and  index  finger,  while  the 


Fig.  174.— Manner  of  holding  a  Lancet. 


140  ELEMENTARY    OPERATIONS. 

handle  rests  on  the  back  of  the  hand,  with  the  fingers  shghtly 
flexed.  The  joint,  brought  close  to  the  skin,  and  perpendicular  to 
it,  is  thrust  by  the  extension  of  the  fingers  through  the  tegument 
and  tissues  underneath  and  then  drawn  out  perpendicularly,  un- 
less it  is  desu^able  to  increase  the  size  of  the  incision,  when  the 
division  is  made  by  extending  the  incision  from  within  outward. 
Puncture  withthe  Straight  Bistoury. — The  bistoury,  for  this 
purpose,  must  be  finely  pointed  and  sharp.  Held  as  a  writing  pen, 
with  its  edge  upward  or  downward,  or  as  a  table-knife,  accord- 
ing to  the  thickness  of  the  tissues,  and  its  action  hmited  by  ha\^ng 
the  fingers  at  a  given  distance  from  the  point,  it  is  pushed  per- 
pendicularly and  more  or  less  rapidly  at  once  to  the  necessary' 
depth.  It  is  then  drawn  out,  unless  the  incision  is  to  be 
enlarged,  which  is  done  by  a  motion  from  within  outward 
by  the  blade.  Sometimes  the  instrument  is  pushed  into  the 
tissues  in  an  obhque,  instead  of  a  perpendicular  dii-ection,  when  it 
is  not  desirable  to  have  communication  between  the  ojDening  of 
the  skin  and  the  one  directly  beneath  it.  This  constitutes  the  first 
step  of  the  subcutaneous  incision. 


Fig.  175.— Trocar  and  Canula. 

Puncture  loith  the  Trocar.  —  This  instrument  is  composed 
of  two  parts.  A  rod,  secm-ed  to  a  firm  handle  at  one  extremity 
and  terminating  at  the  other  in  a  tri-f aced  point,  is  one ;  this  rod 
fits  into  a  canula,  blunt  at  one  end  and  ha\dng  at  the  other  a  cuj)- 
shaped  flange,  which  is  the  other  part.  The  canula  is  long  enough 
to  receive  the  entire  length  of  the  rod,  except  the  tri-faced  j^oint, 
which  projects  beyond  it.  The  two  parts  are  fitted  closely 
together. 

■  Trocars  are  of  various  size  and  form,  being  both  straight  and 
ciun^ed.  That  which  is  used  for  hyovertebrotomy  is  the  longest  of 
all ;  those  used  for  rumenotomy  are  quite  large  in  diameter ;  the 
enterotome  is,  on  the  contrary,  quite  small. 


DISSECTIONS. 


141 


Fig.  176.— Various  Forms  of  Trocars. 


To  puncture  with  the  trocar,  the  operator  will  assure  himself 
that  it  is  in  good  condition,  and  that  the  rod  can  readily  be  with- 
drawn from  the  canula  when  necessary.  Holding  the  instrument 
in  such  a  manner  that  the  handle,  grasped  by  the  three  fingers, 
rests  in  the  j^alm  of  the  hand,  the  thumb  is  applied  on  the  canula 
near  its  point  of  union  with  the  handle,  and  the  index  extended  on 
the  outside  of  it,  to  limit  the  play  of  the  instrument ;  the  trocar  is 
pushed  through  the  tissues  in  a  perpendicular  direction,  and  until 
a  sensation  of  resistance  is  no  longer  felt.  "When  introduced,  the 
canula  is  held  in  place  with  one  hand,  while  with  the  other  the 
rod  is  slowly  drawn  straight  out,  or  by  a  slight  rotary  motion. 

If  the  design  of  the  operation  has  been  the  evacuation  of  the 
liquid  contents  of  a  tumor,  as  the  fluid  escapes  the  growth  dimin- 
ishes, and  it  becomes  necessary  to  insert  the  canula  further  in  the 
ca\ity  or  turn  it  in  different  directions,  to  ensure  the  removal  of  the 
entire  contents.  Yet  it  is  necessary  to  be  careful  not  to  press  the 
orifice  of  the  canula  against  the  waUs  of  the  sac,  a  condition  likely 
to  prevent  the  escape  of  the  fluid. 

To  remove  the  canula,  moderate  pressure  is  applied  with  one 
hand  on  the  skin  around  the  seat  of  the  puncture,  while  the  other 


142  ELEMENTARY    OPERATIONS. 

withdraws  the  instrument  by  its  pavilion,  drawing  it  in  a   line 
parallel  to  the  division  in  which  it  was  introduced. 

Exploring  needles,  or  trocars,  which  are  but  small  directors 
with  a  lanceolate  blade  at  one  end,  and  a  smaU  groove  on  one 
side,  are  also  used  for  making  punctures,  and  their  adaj)tation  as 


Fig.  177.— Exploring  Needles. 


very  small  trocars,  with  aspirators  (j)rincipally  that  of  Dieulafoy) 
find  frequent  use  in  our  surgery.  These  instruments  have  ah'eady 
been  considered  in  the  chaj)ter  upon  surgical  diagnosis. 

The  Puncture  with  the  Actual  Cautery. — The  conical  cautery 
is  the  one  used  in  this  mode  of  operation.  It  varies  in  diameter 
and  in  length.  The  instrument  is  heated  to  a  white  heat,  apphed 
perpendicularly  ujDon  the  skin  and  pushed  in  until  the  sense  of 
resistance  is  no  longer  felt,  when  it  is  vdthdrawn.  The  condition 
of  white  heat  of  the  instrument  is  of  great  importance.  Though 
apparently  an  act  of  great  severity,  the  oj^eration  finds  numerous 
appUcations  in  our  surgical  practice,  principally  for  the  puncture 
of  deep-seated  cold  abscesses.  It  has  great  advantages  over  the 
punctui-e  with  the  bistoviry,  inasmuch  as  there  is  no  hemorrhage 
to  fear  from  its  use ;  because  the  opening  made  by  the  cautery 
remains  unclosed  a  longer  time,  and  because  the  inflammation  is 
modified  in  its  nature,  and  the  process  of  resolution  thus  assisted 
by  the  caloric  thrown  in. 

The  use  of  local  anesthesia,  by  the  injections  of  cocaine,  will 
remove  from  this  mode  of  puncture  the  rough  side  of  its  applica- 
tion by  rendering  the  operation  entirely  painless. 

EEUNION. 

This  term  signifies  the  readjustment  and  consoHdation  of  tis- 
sues which  had  been  disintegrated  and  divided — otherwise,  simply 
the  reuniting  of  separated  parts,  and  their  restoration  to  a  nor- 
mal condition.  This  process  is  otherwise  referred  to  as  that  of 
cicatrization,  a  natural  property  of  organic  tissues,  which,  though 
it  may  be  aided  and  guided  by  the  surgeon,  can  be  controlled  by 


REUNION.  143 

Mm  only  to  the  extent  of  preventing  accidents  and  maintaining 
natui'al  conditions.  The  processes,  the  order,  and  the  rapidity  of 
the  formation  of  cicatrization  are  not  the  same  with  different  tis- 
sues, and  certain  distinctive  terms  have  therefore  been  adopted 
by  which  to  denote  the  modified  ways  by  which  the  pur^DOse  of 
natui'e  is  effected.  Thus  we  have  immediate  reunion  or  adhesive 
hiflammatlon  or  union  by  the  first  intention,  by  which  separated 
parts  sohdify  upon  simple  contact,  as  varying  from  union  by  the 
second  intention,  or  by  granulation  and  suppm-ation  ;  followed  by 
union  by  the  third  intent io?i,  when,  together  with  the  processes  of 
the  second  intention,  there  is  added  one  of  mortification  and  the 
elimination  of  dead  structure.  This  subdivision  accords  strictly 
with  the  order  of  nature,  as  it  may  be  constantly  observed,  the 
phenomena  of  separation  involving  a  regular  gradation  of  de- 
tail in  the  active  forces  employed  in  the  recuj)erative  effort,  from 
the  simplest  and  most  efficient  in  the  uniofi  by  first  intention  to 
that  which  is,  in  fact,  a  struggle  between  the  elements  of  growth 
and  preservation  and  the  tendency  to  dissolution  and  death,  as  ex- 
hibited in  the  third  degree. 

Before  j^roceeding  to  the  direct  discussion  of  the  means  used 
to  assist  the  vis  conservatrix  in  the  reunion  of  divided  parts,  there 
are  some  general  considerations  of  which  the  surgeon  must  never 
lose  sight.  They  are  not  of  the  less  importance  because  they  are 
matters  of  an  obvious  and  secondary  character,  and  refer  mainly  to 
what  may  be  termed  matters  of  minor  detail.  Where  immediate 
reunion  is  looked  for,  the  wound  must  be  fresh  and  clean,  and 
entirely  free  from  clots  of  blood  or  foreign  substances.  The  edges 
must  be  smooth  and  even,  and  if  there  are  any  ragged  portions 
they  must  be  carefully  excised.  In  addition  to  this,  where  there 
is  a  granulating  surface  the  granulations  must  be  carefully  inspect- 
ed and  their  healthiness  assured,  and  the  surgeon  must  search  care- 
fully to  ascertain  that  there  are  no  fistulous  tracts  present.  In  any 
case  the  hair  must  be  cHpped  short  around  the  edges,  the  skin  thor- 
oughly washed,  and,  what  is  a  point  of  primary  importance,  the 
exact  coaptation  of  the  opposite  edges  carefully  ascertained  and 
secured. 

The  means  employed  to  maintain  the  contact  of  the  edges  of  a 
wound,  and  assist  in  its  closure  are,  according  to  Gourdon,  of 
four  kinds — -position,  uniting  bandages,  adhesive  plasters  and 
sutures. 


144  ELEMENTAEY    OPEEATIONa 

A. — Position. 

This  is  more  a  preparatory  step  toward  obtaining  reunion  than 
a  true  means  of  securing  it,  and  to  have  its  full  effect  and  assui-e 
all  its  benefits,  must  be  accomjoanied  by  the  judicious  application 
of  plasters  or  bandages.  By  position  is  understood  such  an  atti- 
tude of  the  patient  as  will  tend  to  keep  in  coaptation  the  sides  of 
the  wound,  as  opposed  to  a  postirre  which  would,  if  left  unguard- 
ed, distui'b  the  immobility  which  is  indispensable  to  the  comple- 
tion of  a  symmetrical  union.  The  natural  restlessness  of  the  pa- 
tient under  the  circumstances,  even  ii-respective  of  the  ordinary 
Habnity  to  the  slighter  causes  which  divert  his  attention  and  ren- 
der immobility  imjjossible,  forbid  the  idea  of  entire  j^assivity.  And 
yet  there  are  some  cases  where  it  is  possible,  or  at  least  must 
be  attempted.  This  may  be  illustrated  by  the  hypothetical  case 
of  a  lacerated  wound,  forming  a  V  shaped  flajD  of  skin,  with  its 
base  tm-ned  upward.  By  taking  advantage  of  this  condition,  and 
keeping  the  apex  of  the  V  downward,  the  p)odtion  of  the  flap  -will 
itself  assist  in  closing  the  wound,  the  edges  having  a  natural  ten- 
dency, from  the  contractive  character  of  the  fibres,  to  form,  and  to 
maintain  the  desirable  contact.  But  if,  on  the  contrary,  the  flap 
has  its  base  turned  downward,  the  difficulty  of  keeping  it  in  its 
proper  position  Avill  be  greater,  proportionately  to  the  tendency  of 
the  edges  of  the  flap  to  drop  away  from  those  of  the  skin.  Taking 
advantage  of  the  position  of  this  peculiar  wound,  and  assisting  it 
by  the  aiDplication  of  bandages  or  other  means,  will  materially 
facilitate  the  closure  of  the  wound. 

B. — Uniting  Bandages. 

Though  these  are  not  so  frequently  required  in  veterinary  as 
in  human  surgery,  they  are  very  effective  in  bringing  together  and 
retaining  the  edges  of  wounds,  especially  in  the  extremities,  where 
in  both  transverse  and  longitudinal  wounds  they  fulfil  their  jDur- 
pose  very  satisfactorily,  esjjecially  where  only  the  skin  is  involved. 
If  the  injury  extends  to  the  muscular  substance,  however,  they 
are  both  more  difficult  to  apply,  and  less  serviceable  in  their  ef- 
fects. In  wounds  of  a  transverse  character,  two  bandages  of  a 
length  equal  to  that  of  the  injured  leg,  and  as  wide  as  the  great 
axis  of  the  wound,  are  required.     One  of  these  is  divided  into 


u:niting  bandages.  145 


Pig.  178.— Bandage  for  Transversal  Wound. 

three  or  four  strips  in  one-half  of  its  length,  the  other  having  in 
its  middle  an  equal  number  of  longitudinal  slits,  smaller  than 
those  of  the  first,  these  two  being  fixed  parallel  to  the  axis  of  the 
leg,  one  above  the  other  below  the  wound,  by  several  turns  of 
rollers,  and  by  passing  the  strijDS  of  one  through  the  correspond- 
ing sHts  of  the  other,  the  edges  of  the  woiind  will,  by  opposite 
traction  upon  the  bandages,  be  necessarily  brought  together  and 
supported  in  that  position  (Fig.  178.) 

The  same  method  answers  for  longitudinal  wounds,  though 
simpler  in  structure ;  this  bandage,  consisting  of  a  single  band  of  a 
width  equal  to  the  length  of  the  wound,  and  prepared  with  strips 
and  corresponding  sHts,  as  just  described,  at  a  distance  of  about 
three-quarters  of  the  circumference  of  the  leg.  Thus  prepared,  and 
compressive  pads  placed  on  each  side  of  the  wound,  the  bandage 
is  manipvdated  as  in  the  other  cases,  and  when  it  is  all  properly 
adjusted,  is  further  secured  by  rolling  it  around  the  leg  over  the 
strips  (Fig.  179.) 

C. — Adhesfve  Sticking  or  Agglutinating  Plasters. 

These  descriptive  terms  refer  either  to  certain  special  mixtures 
which  are  appHed  either  directly,  and  alone  upon  the  solutions  of 
continuity,  or  spread  uj)on  linen,  in  the  form  of  the  ordinary 


146  ELEMENTABY   OPERATIONS. 


Fig.  179.— Bandage  for  Longitudinal  Wounds. 

surgeon's  plasters.  They  are  better  adapted  for  use,  with  the 
smaller,  than  with  the  larger  animals,  answering  all  the  require- 
ments with  the  former  class.  They  are  composed  of  various  in- 
ingredients,  differently  combined,  such  as  black  pitch,  with  resin, 
Venice  turpentine,  etc.,  and  oils,  to  improve  their  flexibihty,  and 
aid  their  curative  qualities. 

Venice  tm-pentine,  alone,  is  sometimes  spread  over  the  bandages, 
also  a  mixture  of  tar  and  Biu'gundy  pitch.  Pitch,  alone,  when 
melted  and  mixed  with  cut  oakum  or  tow,  forms  a  good  adhesive 
mixture.  The  ordinary  adhesive,  or  diachyton,  or  lead  plaster, 
used  in  human  medicine,  is  of  great  value  in  the  surgery  of  small 
animals,  and  we  have  used  it  with  great  satisfaction  with  both 
large  and  small  patients,  appljoag  it  in  long  strips,  rolling  them 
around  the  affected  region  in  two  or  thi'ee  thicknesses.  Collodion 
has  also  been  highly  recommended.  Either  alone,  or  appHed  with 
thin  linen,  or  what  is  better,  with  wadding,  it  forms  over  the  sur- 
face of  a  wound,  not  only  an  adhesive  plaster,  but  also  a  jDrotec- 
tive  dressing.  Plasters  are,  in  some  cases,  used  alone  as  means  of 
reunion,  and  in  the  treatment  of  fractures,  they  form  a  powerful 
adjunct  in  controlling  the  displacements  of  fragments  of  bone. 
They  are,  however,  also  frequently  used  to  reinforce  other  means 
of  reunion,  and  especially  deep  sutures. 

D. — Sutures. 
In  all  the  category  of  sui'gical  detail,  there  is  nothing  so  effec- 
tive, or  indeed  indispensable,  as  the  suture,  properly  apphed,  for 


SUTURES.  147 

the  retention  of  breaches  of  continuity,  whether  the  sewing  be 
done  by  means  of  Hnen  or  silk  thread,  animal  fibre,  metallic  wire, 
needles,  j)ins  or  other  instruments.  By  no  other  means  can  the 
parts  be  held  in  the  necessary  coaptation  to  insure  a  perfect 
reunion.  The  sutvire  is  available  for  various  purposes.  Besides 
contributing  materially  to  the  coaptation  of  the  edges  of  a  wound, 
and  thus  aiding  to  secure  a  cicatrization  by  first  intention,  it  pre- 
vents the  contact  and  introduction  of  air  into  a  wound,  arrests 
and  prevents  hemorrhage,  keeps  in  place  lacerated  fragments  of 
deep  wounds  which  could  not  be  controlled  by  bandages  alone, 
assists  in  the  closure  of  artificial  openings,  such  as  may  take  place 
in  the  walls  of  the  abdominal  cavity,  and  prevents  the  escajDC  of 
any  portion  of  its  contents,  and  assists  in  the  closing  of  natural 
openings.  But,  though  principally  useful  in  efltecting  the  objects 
enumerated,  the  essential  indication  of  the  suture  appears  in  the  re- 
union of  solutions  of  continmty,  and,  particularly,  in  regions  where 
the  natiu-al  movements  of  the  parts  tend  necessarily  to  prevent 
the  borders  of  the  wound  from  remaining  in  undisturbed  contact, 
for  a  period  sufficient  to  obviate  the  danger  of  serious  blemishes 
of  cicatrization.  But  while  the  suture  is  of  no  less  advantage  in 
fresh  injuries,  it  is  also  indicated  as  well  in  suppurating  wounds, 
with  the  precaution  of  leaving  room  for  the  free  escape  of  j^atho- 
logical  secretions. 

Sutures  are  contra-indicated,  when  a  wound  becomes  the  seat 
of  extensive  inflammation,  or  occupies  a  broad  surface,  or  is  ir- 
regular, or  accompanied  by  loss  of  tissue ;  or  when  the  parts  are 
the  seat  of  severe  contusion,  or  contain  foreign  bodies  or  mortified 
tissues  in  their  depths.  There  are  other  cases  also,  where  their 
employment  is  contra-indicated,  as  when  their  object  is  likely  to 
be  defeated  by  the  uncontrollable  movements  of  the  patient. 
Causes  of  failure  may  also  sometimes  be  found  in  the  irritation 
arising  from  the  material  of  which  the  suture  is  formed,  cutting 
its  way  loose.  By  this  accident,  a  wound  which,  if  not  interfered 
with,  would  have  left  but  little  if  any  cicatrix,  and  would  have 
required  but  a  short  time  to  heal,  becomes  transformed  into  a 
large,  ugly,  granulating  surface,  that  is  likely  to  leave  a  compara- 
tively bad  looking  cicatrix  in  the  end. 

The  application  of  these  retentive  stitches  falls  under  the 
general  rules  relating  to  the  disjiosltlon  of  the  edges  of  the  wound, 
and  the  special  placing  of  sutures.    In  reference  to  the  first  point, 


148  ELEMENTARY    OPEKATIONS. 

the  first  consideration  to  be  noted  is,  that  the  wound  must,  of 
course,  be  thoroughly  cleaned,  and  free  from  blood  or  foreign 
bodies.  Then  the  borders  of  the  wound  mu^t  be  fresh,  or,  if  old, 
blackish,  or  beginning  to  granulate,  must  be  sHghtly  excised  by 
thin  scrajjing,  and  the  edges  brought  as  closely  in  contact  as 
possible. 

To  apply  the  suture,  the  needle  is  to  be  held  and  used  precisely 
like  an  ordinary  sewing  needle.  If  the  skin  is  thick  enough  to  requii-e 
it,  a  thimble  can  be  used.  Sometimes  special  needles  with  handles 
are  made,  and  sometimes  forceps  may  be  needed  to  grasjD  the 
needle,  and  push  or  pull  it  through  the  integument.  Tlie  needle 
should  pass  through  the  skin  as  nearly  peri^endicularly  as  jDOSsible, 
since,  if  introduced  too  obliquely,  the  tractions  upon  the  skin  may 
be  sufficiently  uneven  to  involve  the  possibility  of  tearing  out  the 
stitch.  In  placing  the  sutiu'e,  nerves,  tendons  and  blood  vessels 
must,  of  coiirse,  be  avoided.  The  suture  should  embrace  a  good 
hold  of  the  skin  to  secure  a  greater  traction  and  better  aj^proxi- 
mation  of  the  parts  ;  the  distance  between  the  stitches  must  be 
such  that  no  gaping  can  take  place ;  they  must  be  disposed  at 
regular  distances  apart.  "When  the  needle  is  introduced  from 
without  inward,  the  skin  is  raised  with  the  fingers  of  the  left 
hand,  or,  better,  with  a  forceps ;  if  introduced  from  within  out- 
ward, pressure  is  to  be  made  upon  the  skin  with  the  fingers  or 
the  blunt  blade  of  a  pair  of  scissors,  near  the  point  of  exit  of  the 
needle. 

Generally,  the  suture  is  begun  at  the  middle  of  the  wound,  in 
which  case  the  edges  are  made  to  meet  more  accurately  and  regu- 
larly. This  rule,  however,  will  find  numerous  exceptions.  All 
the  stitches  should  be  placed  before  any  are  tied,  and  they  must 
be  tied  only  sufficiently  tight  to  keep  the  edges  together ;  other- 
wise they  may  cut  through  the  skin.  If  not  sufficiently  tight  the 
•wound  will  be  left  gaping  and  cicatrization  will  be  interfered  with. 
The  knots  ought  to  be  placed  as  much  as  possible  on  one  side  of 
the  wound  and  towards  the  most  dependent  part,  to  avoid  their 
being  soiled  by  the  suppuration. 

The  material  used  for  sutvires  varies  much.  Strong  Hnen 
thread,  silk,  metallic  wires  of  silver,  lead  or  tin,  and  in  some  cases 
narrow  and  thin  elastic  cords  or  bands  are  used,  according  to  the 
circumstances.  Metallic  wires  have  the  advantage  of  being  less 
irritating,  and  can  remain  in  the  thickness  of  tissues  without  giv- 


149 


ing  rise  to  excessive  inflammation  or  ulceration  if  the  swelling 
should  be  extreme.  Elastic  cords  or  bands  have  an  important 
advantage  in  their  proj^erty  of  yielding  to  the  inflammatory  swell- 
ing, as  it  develops  itself  while  avoiding  dangerous  or  unnecessary 
traction. 


Fig.  180.— Various  Sutured  Needles. 

Suture  needles  are  made  in  countless  forms  and  numbers, 
straight  and  curved,  and  of  diffei-ent  lengths  and  dimensions,  but 
having,  all  of  them,  flat  points.  "\,\Tien  metaUic  sutiu'es  are  used, 
their  extremity  is  grooved  to  receive  the  wire  in  such  a  manner 
that  its  double  thickness  will  not  interfere  with  its  passage 
through  the  skin. 


150 


ELEMENTARY    OPERATIONS. 


Some  needles  are  armed  and  protected  witli  bandies,  as  those 
of  Trelat,  of  Eiverdin,  and  of  SimjDSon.  Sometimes  tlieir  lanceo- 
lated  jDart  has  the  eye  pierced  in  its  center ;  in  others,  the  eye  is 
merely  a  notch,  closed  by  a  repulsor,  moved  by  sHding  through 
the  handle.  Generally,  the  hand  is  sufficient  to  push  the  needle 
through  the  skin,  but  at  times,  as  has  been  mentioned,  forceps  or 
needle-holders  are  necessary,  such  as  the  needle-holder  of  Mat- 
thieu,  an  ordinary  forceps  or  an  ordinary  pin-holder.  The  com- 
mon "vrire  dressing  pin  is  also  included  among  sutui'e  implements, 


SIMPLE    OR   INTERRUPTED    SUTURE. 


151 


Fig.  186.— Suture  Forcepa. 


Fig.  1S7.— Needle  or  Pin  Holder. 


but  is  not  always  efficient  from  lack  of  rigiclity,  when  a  stronger 
and  less  flexible  implement  becomes  necessary. 

Sutures  are  of  many  kinds,  some  being  superficial,  others  deep, 
and  otherwise  classified,  according  to  the  requirements  of  their 
application,  into  single,  as  when  the  thread  or  wire  alone  main- 
tains the  reunion,  or  compound,  when  it  requires  other  and  acces- 
sory means,  such  as  needles,  joins,  quills,  etc.,  etc. 

1.  The  simple  or  interrupted  suture  (Fig.  188)  is  formed  of  dis- 
tinct stitches  between  the  borders  of  the  wound,  each  being  tied 


152 


ELEMENTARY    OPERATIONS. 


Fig.  188.— Simple  or  Interrupted 
Suture. 


Fig.  189.— Looped  Suture. 


separately.  It  is  made  in  two  ways.  By  a  first  procedui'e,  with  a 
needle  holding  a  long  thread,  the  surgeon  holding  both  edges  of 
the  wound,  passes  it  through  both  at  once,  cutting  the  thread  and 
making  each  stitch  entirely  distinct,  and  tying  then  only  when 
they  are  all  in  place.     He  begins  with  the  center  stitch. 

In  the  second  procediu-e,  a  separate  thread  is  prepared  for 
each  stitch,  having  a  needle  at  each  end,  which  is  passed  through 
the  skin  from  within  outward,  and,  as  before,  each  stitch  is  tied 
independently  of  the  others.  Often,  only  a  single  needle  is  used, 
making  the  first  half  of  the  stitch  from  without  inward,  and  the 
second  half  from  within  outward. 

This  suture  is  used  for  recent  wounds,  and  those  in  which 
there  is  extensive  laceration  of  the  integument. 

2.  Looped  Suture  (Fig.  189). — This  is  an  interrupted  suture, 
in  which  the  threads,  instead  of  being  tied  vq)  separately  over  the 
wound,  are  twisted  together  on  each  side,  without  being  tied,  in 
order  that  each  thread  may  be  removed  independently  of  the  others, 
if  necessary.  The  cords  are  then  twisted  together,  and  sometimes 
tied  and  sometimes  not. 

It  was  formerly  recommended  for  intestinal  wounds,  and  is  but 
little  used  at  the  present  time. 

3.  Uninterriqyted  or  Glover's  Suture  (Fig.  190). — This  is  a  con- 
tinuous suture,  of  which  the  stitches  successively  cross  the  wound 
from  both  within  and  without.  In  making  it,  the  thread  is  knot- 
ted at  the  end,  and  the  needle  pushed  through  the  skin  at  one  ex- 
tremity of  one  of  the  borders  of  the  wound,  from  without  inward, 
and  then  directly  opposite  it  through  the  other  edge,  brought  to 


DOSSILED    SUTURE. 


153 


the  first  in  crossing  the  wounds  obhquely,  and  this  is  repeated 
until  the  lower  end  of  the  edge,  oj^posite  to  that  at  which  the 
suture  was  begvm,  is  reached,  when  the  thread  is  stopped  by  a 
knot.  Before  securing  the  last  stitch,  care  must  be  taken  to  re- 
move any  j)ossible  wrinkles  between  the  stitches. 


5IS  ^ 


Fig.  190.— Glover's  Suture. 


Fig.  191.— Dossiled  Suture. 


4.  Dossiled  /Suture  (Fig.  191). — This  is  a  variety  of  interrupted 
sutm*e,  in  which  the  thread  is  doubled,  and  at  one  end  carries  a 
little  ball  or  dossil  of  lint  or  oakum.  Passed  through  one  edge 
of  the  wound  from  without  inward,  it  is  brought  outside  of  the 
wound,  and  cut  the  necessary  length.  Another  similar  thread  is 
passed  through  the  other  border  in  a  similar  way,  and,  when  cut, 
both  threads  are  tied  together  in  the  center  of  the  wound. 

This  suture  is  often  used  for  the  purpose  of  holding  in  place 
the  substances  (wadding,  oakum,  etc.)  that  may  be  placed  in  the 
wound,  or  to  prevent  the  retui-n  of  a  hemorrhage.  It  is  a  strong- 
adjuvant  of  other  hemostatic  measures. 

5.  Quilled  /Suture  (Fig.  192). — This  is  formed  by  a  series  of  in- 
terrupted stitches,  supported  on  each  side  by  a  short  piece  of  quill 
or  wood,  or  metallic  pin,  which  must  be  longer  than  the  great  axis 


h' 


J     K 


-Quilled  Suture. 


Fig.  193.— Suture  with  Adhesive  Bandage. 


154  ELEMENTARY    OPERATIONS. 

of  the  wound.  To  apply  it,  a  double  tkread,  with  the  ends  knot- 
ted, is  passed  through  the  edges  of  the  wound,  and  several  stitches 
made  in  succession,  as  in  the  regular  simple  interrupted  suture. 
When  these  are  in  place,  the  support  (quill,  pencil  or  otherwise)  is 
passed  through  the  lap  of  each  double  thread  on  one  side  of  the 
wound.  Drawing  this  first  quill  close  to  the  skin,  the  threads  are 
separated,  and,  between  them,  a  second  quill  appHed  on  the  other 
border  of  the  wound,  and  secured  in  place  by  a  knot. 

This  suture  is  recommended  for  wounds  of  the  abdomen.  Peuch 
and  Toussaint  recommend  it  after  the  removal  of  mammary  tumors 
in  bitches.  Sometimes  elastic  cords  are  used,  in  preference  to  or- 
dinary threads,  as  being  less  putrescible,  and  jdelding  better  to  the 
inflammatory  swelling,  etc. 

Director  Degive  frequently  employs  the  elastic  suture  wit/i  ad- 
hesive bandages  (Fig.  193). 

Two  adhesive  bandages,  of  dimensions  proportionate  to  that 
of  the  wound,  are  glued  on  each  side  of  it.  These  carry  near  the 
border,  in  the  neighborhood  of  the  edges  of  the  wound,  small 
holes,  through  which  elastic  rings  are  passed.  These  rings  repre- 
sent the  threads  used  in  the  other  mode  of  procedure,  and  through 
these  rings  the  quills  or  pins  are  placed,  which  will  rest  on  the 
outside  of  the  bandages  and  keej)  them  in  place. 

6.  The  single  ^nn  suture  is  a  simple  opera- 
tion for  small  wounds,  commonly  used  as  the 
last  step  of  the  operation  of  bleeding,  and  b}' 
which  both  edges  of  the  wound  are  brought 
Fig.  194.— Single  Pin     together  with  a  pin,  and  seciu'ed  by  a  special 
Suture.  double  loop  or  hitch  called  the  bleeding  knot. 

7.  Twisted  Suture  (Figs.  195,  196).— This  is  frequently  used 
for  wounds  of  the  eyelids  or  of  the  nostrils.  It  consists  in  placing 
through  the  borders  of  the  wound  as  many  pins  as  may  be  neces- 
sary, and  holding  them  by  twists  of  thread.  Ordinary  pins  are 
generally  used  in  veterinary  surgery. 

The  pins  are  secured  in  different  ways.  In  one  case,  the  twists 
are  so  made  as  to  form  a  series  of  figure  8s,  placing  them  two  or 
three  times  successively,  first  around  the  pin  at  one  extremity  of 
the  wound  and  relocating  the  movement  with  each  pin.  In  an- 
other way,  instead  of  making  a  figui-e  8,  the  threads  are  turned 
arovmd  the  pins  at  each  stitch,  suiTounding  all  Avith  a  circular 
thread. 


ZIGZAG   SUTUKE. 


155 


Fig.  195.— Twisted  Suture.  FiG.  196.— Another. 

Some  veterinarians,  in  making  this  compound  pin  suture,  prefer 
the  use  of  elastic  rings  to  that  of  the  circular  or  figure  8  threads. 
"VVe  have  personally  used  these  rings  with  very  satisfactory 
results. 

8.  Zigzag  Suture  (Fig.  197). — This  is  a  continued  suture  in 
which  the  thread  is  made  to  cross  and  re-cross  from  one  border  of 
the  wound  to  the  other.  The  procediu'e  is  as  follows:  a  needle 
carrying  a  long  thread  is  passed  through  one  edge  of  the  wound 
from  without  inward,  and  through  the  other  in  a  straight  direc- 
tion from  within  outward.  Starting  with  the  same  thread,  a  sec- 
ond stitch  is  taken  at  some  distance  from  the  first,  and  on  the 
same  side  of  the  wound  on  which  the  first  was  ended,  a  second 
stitch  is  made  by  passing  the  needle  from  without  inward,  and 
back  from  within  outward,  to  reach  the  side  of  the  wound  where 
the  first  stitch  was  started  at  an  equal  distance  from  it.  The  re- 
maining stitches  are,  of  course,  made  in  the  same  manner. 

This  sutui-e  has  been  recommended  for  the  treatment  of  um- 
bilical hernia  in  soUj)eds. 

9.  Suture  of  the  Furrier. — This  is  performed  with  a  needle  and 
a  long  thread,  which  is  alternately  passed  thi'ough  the  edges  of 
the  wound  from  without  and  from  within.    It  is  also  a  continuous 


^""^  '^ 


rTTXT 


Fig.  197.— Zigzag  Suture. 


Fig.  198.— Suture  of  the  Furrier. 


156 


ELEMENTAEY    OPERATIONS. 


K\/\ 


M 


Fig.  199.— T  Suture. 


Fig.  200.— X  Suture. 


suture,  in  which  the  coaptation  of  the  borders  of  the  wound  is 
regular  and  exact.  It  is  principally  apj)licable  when  the  borders 
of  the  wound  have  a  tendency  to  overlap  each  other. 

10.  T  Suture  (Fig.  199). — This  is  the  peculiar  stitch  used  to 
bring  together  the  borders  of  a  T  or  crucial  incision.  A  thread  is 
used  with  a  needle  at  each  end,  each  of  which  is  passed  through 
from  without  inward,  in  one  of  the  angles  of  the  T,  and  brought 
from  within  outward  beyond  the  transverse  incision  of  the  T  when 
being  unthreaded  and  laid  aside.  The  suture  is  completed  by 
tying  the  two  ends  of  the  thread  together. 

The  same  suture  could  be  made  with  a  single  needle. 

The  same  procedure  is  required  for  the  crucial  incisions. 

11th.  JC  Suture  (Fig.  200). — This  suture,  which  is  recommend- 
ed after  spaying  sows,  is  made  by  taking  a  stitch  through  both 
edges  at  once,  and  canndng  the  thread  obliquely  across  the  wound, 
starting  the  second  stitch  on  the  same  border  of  the  wound  as  the 
first,  and  finishing  in  the  same  manner ;  the  thread  is  then  again 
passed  across  the  wound,  and  the  ends  tied  together. 

12th.  Metallic  Sutures. — These  do  not  differ  from  the  sutures 
which  we  have  considered,  excepting  that  metals  are  used  instead 
of  thread  or  silk.  They  are  applied  like  the  others,  and  secured  in 
the  same  manner,  by  knots  or  by  twisting  their  ends  together. 

The  period  for  the  removal  of  sutures  dejDends  upon  many 
circumstances,  and  varies  according  to  the  nature  of  the  tissues 
involved,  then-  thickness,  and  the  species  of  the  animals  operated 
on.  In  horses  and  in  dogs,  suppuration  occurs  more  rapidly  than 
in  ruminants  or  swine,  and  on  that  account  the  sutures  cannot  be 
allowed  to  remain  as  long,  without  giving  rise  to  the  formation  of 
pus.  Moreover,  in  regions  where  cellular  tissues  and  blood  vessels 
are  abundant,  the  pus  is  usually  formed  more  rapidly  than  in  those 


REMOVAL    OF    SUTURES.  157 

of  the  opposite  formation,  and  consequently  sutures  must  be  re- 
moved earlier.  On  general  principles  tliey  should  be  taken  out  by 
the  fourth  or  fifth  day,  or  even  sooner,  if  indications  of  complica- 
tion due  to  their  presence  are  manifested. 

In  removing  sutures,  it  is  necessary  to  proceed  cautiously,  in 
order  to  avoid  breaking  any  adhesions  that  may  have  been  formed. 

As  a  general  rule,  but  one  should  be  detached  at  a  time,  be- 
ginning at  the  least  important  point.  The  threads  and  needles 
should  be  cut  close  to  the  side  opposite  to  that  on  which  they  are 
to  be  extracted ;  they  must  be  carefully  cleaned  of  crusts  or  dried 
pus  and  any  I'oughness  whatever,  and  the  sldn  should  be  carefully 
held  down  as  they  are  slowly  drawn  out.  If  the  adhesion  seems 
at  any  points  to  be  too  Mght,  the  sutures  must  be  left  in  a  few 
days  longer.  The  appHcation  of  adhesive  mixtures,  or  of  collodion, 
will  strengthen  a  weak  cicatricial  tissue. 

When  a  suture  has  been  apphed,  as  well  as  when  it  has  just 
been  removed,  it  is  sometimes  necessary,  in  order  to  prevent  the 
animal  from  biting  or  rubbing  the  cicatrix,  to  bring  the  cradle  or 
the  side  bar  into  requisition. 


CHAPTEE  V. 

OPERATIONS   ON  THE  SKIN   AND 
CELLULAR  TISSUE. 

CAUTERIZATION. 

The  theory  of  the  cautery  is  the  irritation  and  disorganization 
of  living  tissues,  either  by  the  immediate  contact  of  heat  or  of 
chemical  substances,  producing  an  analagous  effect  on  the  organ- 
ism. Cauterization  is  thus  of  two  kinds,  the  actual  and  the  poten- 
tial, according  to  the  agent  employed  in  its  production. 

Potential  cauterization,  by  reason  of  the  nature  of  the  agents 
employed,  as  well  as  of  the  method  of  employing  them,  belongs 
properly  to  the  domain  of  therapeutics,  and  we  shall  therefore  pass 
the  subject  by  with  a  simple  mention,  to  give  om-  attention  to 
what  falls  more  particularly  under  the  head  of  operative  sm-gery, 
the  actual  cautery. 

ACTUAL  CAUTERIZATION  OR  FIRING. 

Firing  is  one  of  the  most  valuable  of  therapeutic  agencies.  It 
is  also  one  of  the  oldest  and  best  known  among  methods  of  surgi- 
cal treatment,  in  both  human  and  veterinary  medicine.  It  was 
practiced  and  recommended  as  far  back  as  the  times  of  Columelle, 
Absyrtus  and  Yegetius,  when  it  was  in  high  repute  as  a  remedy 
for  articular  diseases,  sprains  and  weakness  of  the  loins ;  but  to- 
wards the  15th  century,  its  popularity  waned  somewhat,  and  it 
seemed  to  have  partially  lost  favor,  vintU  the  days  of  Markam  and 
Gray  in  England,  and  Solleysel  in  France,  where  it  regained  by 
degrees  its  former  repute.  It  now  holds  an  estabhshed  j^lace 
among  regular  and  methodical  operations,  and  is  one  of  the  most 
important  among  our  surgical  resources,  apphcable  in  many 
pathological  conditions,  and  efficacious  in  most.  The  following 
long  Hst  of  ailments  and  lesions  in  which  it  may  be  indicated  is 
given  by  Bouley. 


ACTUAL    CAUTERIZATION    OR    FIRING.  159 

(«)  Diseases  of  Joints. — Exostoses  around  the  borders  of 
articular  surfaces  ;  sprains  of  ligaments ;  dilatations  of  synovial 
bursjB  and  indurations  of  their  walls ;  dislocations ;  true  or  false 
anchylosis ;  deformities  of  the  extremities  from  excess  of  work ; 
congenital  general  weakness,  etc. 

{!))  Diseases  of  Bones. — ^Exostoses;  periostosis;  callus  of 
complete  or  incomplete  fractures ;  caries ;  necrosis. 

(c)  Diseases  of  Tendons. — Partial  lacerations ;  chronic  swelling 
after  tenotomy. 

{d)  Diseases  of  Tendinous  Sheaths. — Dilatation ;  lacerations ; 
changes  in  the  structure  of  their  walls. 

(e)  Diseases  of  Muscles. — Atrophy;  induration;  pathological 
changes  of  structure. 

(/')  Diseases  of  the  Cellular  Tissues.  —  Chronic  oedematous 
swellings;  indiiration;  abscesses;  cysts. 

(g)  Diseases  of  the  Nervous  Apparatus. — Paralysis;  occult 
pains  without  visible  lesions. 

(A)  Diseases  of  the  Lymphatic  System — Chronic  lymphangitis ; 
f arcinous  cords ;    pustules  or  tumors. 

(^)   Diseases  of  Veins. — Chronic  phlebitis. 

{j)   Diseases  of  Arteries. — Hemorrhages. 

{k)  Special  Diseases. — Carbuncular  tumors;  gangrene ;  ulcers  ; 
fistulas,  etc. 

To  epitomise  and  simpUfy  this  long  recapitulation,  we  may  say 
with  Gourdon,  that  the  use  of  the  actual  cautery  is  indicated  when 
its  characteristic  effect  as  an  excitant  and  tonic  is  sought  for  in 
atrophy,  or  in  diseases  of  joints;  or  again,  as  a  modifying  factor 
in  chronic  inflammation ;  as  a  derivative,  and  as  a  physical  or  a 
preventive  agent. 

It  is  contra-indicated  in  cases  where  there  exists  an  excess  of 
vital  irritation,  or  of  inflammatory  tendency,  until  the  symptoms 
which  attend  such  a  state  of  the  system  have  more  or  less  sub- 
sided. 

Actual  cauterization  is  divided  into  the  superficial  and  the 
deep,  the  former  being  again  subdi\dded  into  the  mediate  and  the 
immediate.  In  the  immediate  the  iron  is  appHed  directly  to  the 
skin,  while  in  the  mediate  the  action  is  supposed  to  be  modified 
by  the  interposition  of  some  kind  of  medium. 

The  various  modes  of  actual  cauterization,  according  to  Bonley, 
are  systematically  exhibited  in  the  following  table : 


160 


OPERATIONS   ON    THE    SKIN   AND    CELLULAR    TISSUE. 


Superficial. 


Immediate . 


Mediate. 


Penetrating 


Subcutaneous. 


Transcurrent,  in  lines. 
On  surface,  a  la  Gaulet. 
In  points  or  dots. 
By  ignited  bodies. 
By  heated  liquids. 
^  By  radiation  or  objective. 

By  the  interposition  of 
kid  skin  or  of  a  layer 
of  lard. 


r  Rapid. 

[  Inherent  or  disorganizing. 


Peuch  and  Toussaint  have  added  the  needle  cauterization,  and 
firing  v^dth  the  thermo-cautery. 

Overlooking  several  of  these  specifications,  which  are  of  Uttle  or 
no  utility,  such  as  the  firing  with  the  inter-position  of  ignited  bodies, 
of  heated  liquids,  kid  skin,  etc.,  we  proceed  to  consider  the 
various  prevalent  and  established  modes  in  daily  practice  and  of 
general  utility. 

Transcurrent,  or  Firing  in  Lines. 

The  Cautery. — The  instrument  used  in  all  these  operations, 
while  formerly  made  of  different  metals,  is  now  made  exclusively  of 
iron,  for  which  there  are  various  reasons.  It  is  not  only  because 
of  its  cheapness  and  excellence  and  the  general  quahties  which 
give  it  universal  precedence  in  the  arts,  but  for  some  reasons  pe- 
cuhar  to  the  case.  Thus,  its  changes  of  color  when  heated,  render 
it  easy  to  gauge,  proximately,  the  degree  of  heat,  and  it  also 
possesses  the  property  of  retaining  heat  longer  than  many  other 
substances. 

The  form  of  the  cautery  varies  greatly.  The  style  most  com- 
monly in  use  resembles  a  small  hatchet,  of  triangular,  prismatic 
shape,  thick  at  its  base  and  with  a  thin  border  or  edge,  sometimes 
convex,  sometimes  straight,  and  more  or  less  sharj),  according  to 
the  indication.  The  handle  is,  of  course,  of  wood  or  other  non- 
conducting material,  and  in  respect  to  the  weight,  reference  must 
be  had  to  facility  of  handling  and  power  of  retaining  heat.     The 


THE   CAUTEKT. 


IGl 


Pig.  SOI.— Various  Cauteries. 


lighter  ones  are  usually  preferred,  not  only  on  account  of  this 
facility,  but  as  being  less  liable  to  produce  too  pronounced  an 
effect. 

Heavy  instruments,  in  consequence  of  the  degree  of  heat  they 
radiate,  and  their  contact  with  a  broader  surface  of  skin,  are  liable 
to  transform  the  firing  into  the  condition  of  a  mere  burn. 

The  size  of  the  cautery  will  necessarily  be  regulated  by  the  ex- 
tent of  the  region  to  be  treated.  The  cautei*y  must  be  perf  ectty 
smooth,  on  its  surface  as  well  as  on  its  thin  edge,  and  to  ascertain 
that  this  is  the  case,  before  they  are  heated  a  file  should  be  passed 
over  both  surfaces,  and  before  being  appUed  to  the  skin  they 
should  be  again  inspected  by  the  surgeon  or  an  assistant,  to  be 
assured  that  the  edge  is  clear  and  clean,  and  there  is  no  roughness 
to  cause  a  ragged  and  uneven  line  on  the  skin. 

In  heating  the  cautery,  a  charcoal  fire  is  much  to  be  preferred 
to  that  from  the  l^lacksmith's  forge.  The  latter  soon  soils  and 
blackens  the  instrument,  while  the  former  is  smokeless  and  every 
way  cleaner,  besides  being  portable  and  always  convenient. 

There  is  no  uniform  rule  to  govern  the  position  iu  which  the 
animal  must  be  secured.  While  there  are  occasions  when  he  can 
be  treated  while  standing,  and  kept  under  control  by  the  simple 
means  of  restraint,  in  many,  and  indeed  in  a  majority  of   cases. 


162 


OPERATIONS    ON    THE    SKIN    AND    CELLULAR    TISSUE. 


it  will  be  everyway  advantageous  to  have  tlie  patient  thrown  down 
and  secured,  in  order  that  the  region  to  be  fired  may  be  exj)osed 
as  freely  as  j)Ossible — a  point  which  has  already  been  considered. 

The  parts  upon  which  the  firing  is  to  be  made  must  be  thor- 
oughly cleaned  and  es]Decially  free  from  scabs  or  greasy  sub- 
stances. The  hail-  is  to  be  chpped  short  whenever  its  length  and 
thickness  are  likely  to  interfere  with  the  action  of  the  instrument ; 
yet  the  skin  must  not  be  shaved,  inasmuch  as  a  thin  coat  of  hair 
will  always  prove  rather  an  assistance  than  otherwise,  in  drawing 
the  first  lines,  by  preventing  the  instrument  from  sHpping. 

There  was  a  period  when  animals  were  fired  with  a  view  to 
their  alleged  ornamentation,  without  any  pretext  of  necessity  aris- 
ing from  disease,  but  simj^ly  in  conformity  to  the  behest  of  fash- 
ion (and  possibly  as  a  means  of  the  identification  of  property),  but 
this  artistic  firing  for  fashion's  sake  is  now  altogether  discarded, 
and  the  burned-in  shapes  of  fern  leaves,  stars,  crosses,  harps,  etc.. 


m.  —  — T—  — 


Fig.  202.— Old-fashioned  Drawings. 


etc.,  have  made  room  for  firings  inflicted  for  better  reasons  and 
with  more  beneficient  and  valuable  results. 

And  while  the  results  of  these  sesthetic  and  artistic  firings 
made  for  purposes  of  embeUishment  were  usually  ugly,  un- 
sightly cicatrices,  thickened  and  hairless,  the  operations  of  the 
present  time  leave  as  their  sequelae  but  sHght  and  superficial 
marks,  which  are  hardly  entitled  to  rank  as  blemishes,  though  in 
this  connection  must  not  be  included  the  Prange  firing  (Fig.  203), 
which,  with  its  pecvdiarity,  is  applied  as  the  ordinary  line  firing, 
except  that  the  Hnes  are  divided  in  small  sections. 

Firing  in  hnes  must  be  appUed  not  only  upon  the  diseased 
part,  but  must  extend  somewhat  beyond  it,  and  the  lines  must  be 
made  as  nearly  as  possible  parallel  with  the  direction  of  the  hair. 


FIEING    IN    LINES. 


163 


Fig.  204.— Various  Forms  of  Drawing  in  Firing.* 
^e  firing  on  the  loins  we  think  ought  to  be  parallel  to  the  median  Une  instead 


of  oblique. 


164  OPEKATIONS    ON    THE    SKIN    AND    CELLULAR    TISSUE. 

Tliis  riile  we  consider  a  very  important  one,  although  it  is  known 
that  European  veterinarians,  when  operating-  in  some  special  re- 
gions, entirely  disregard  it,  firing  in  lines  running  at  right  angles 
with  the  direction  of  the  hair,  though  it  is  quite  obvious  that  the 
result  must  be  an  irregularity  in  the  growth  of  the  hair  and  a 
wavy  appearance,  which  can  be  entirely  avoided  by  observing  the 
rule  we  have  referred  to. 

A  glance  at  Fig.  204  will  give  the  reader  an  idea  of  the  proper 
form  for  making  the  di-awings  and  the  directions  of  the  lines. 
Not  only  should  the  Unes  run  parallel  with  the  direction  of  the 
hah",  but  it  is  eqiially  important  that  there  should  be  no  deviation 
in  the  width  of  the  intervals  between  the  lines.  It  would  be  im- 
possible to  give  exactty  the  distance  which  must  separate  them, 
as  this  depends  upon  the' thickness  of  the  skin,  the  condition  of 
the  patient  and  the  effects  to  be  produced. 

In  drawing  the  lines  it  must  be  remembered  that  they  ought 
to  be  of  an  even  depth  their  entire  length,  but  we  do  not  think 
that  this  can  be  easily  accomphshed  with  the  instrument  having 
the  convex  edge,  while  there  should  be  no  considerable  difficulty 
in  effecting  it  by  a  steady  and  uniform  manipulation  with  the 
straight  edged  iron,  and  by  merely  raising  the  hand  at  the  begin- 
ning of  the  hne  and  depressing  it  shghtly  at  the  end. 

The  cautery  must  never  be  passed  in  one  Hne  against  the 
growth  of  the  hair,  and  by  always  drawing  it  toward  himself  the 
operator  will  avoid  injuring  the  bulbs,  and  escaj)e  the  danger  of 
causing  a  subsequent  abnormal  growth  of  hail'.  Nor  should  the 
cautery  be  passed  twice  in  succession  in  the  same  line.  If  the  in- 
strument should  shp  out  of  its  track  before  reaching  half  its 
length,  the  line  should  be  abandoned  and  the  next  one  proceeded 
with.  To  determine  the  lines  correctly,  and  follow  them  accu- 
rately by  the  eye  alone,  requires  a  natural  aptitude  which  all  do  not 
possess.  It  is  an  art,  however,  which,  if  possible,  should  be  ac- 
quired, and  as  well  as  when  existing  naturally,  cultivated  and  im- 
proved, by  study  and  practice.  But  in  the  absence  of  the  natural 
faculty,  Avhich  it  is  so  desirable  for  the  surgeon  to  possess,  resort 
must  be  had  to  the  obviously  reliable  expedient  of  previous  mark- 
ing, by  which  a  charcoal  mark  upon  a  light-haii-ed,  or  a  chalk  mark 
upon  a  dark  animal  will  obviate  all  risk  of  lack  of  symmetry  and 
want  of  regularity. 

The  degree  to  which  the  cautery  should  be  heated,  as  well  as 


RULES    FOR    APPLYING    THE    CAUTERY.  165 

the  manner  in  wliieli  it  must  be  moved  on  the  skin,  is  to  be  deter- 
mined by  the  steps  of  the  operation.  In  beginning  the  markings 
of  the  firing  or  the  initial  drawing,  the  iron  must  be  of  a  dark  red 
color,  just  hot  enough  to  burn  the  thin  coat  of  hair  left  on  the 
skin.  By  this  method,  any  u-regularity  in  the  drawing  can  be  re- 
moved and  corrected  by  the  passing  of  a  second  instrument. 
When  the  entire  surface  has  been  covered  with  the  initial  draw- 
ings, and  everything  is  correct,  the  heat  of  the  cautery  can  be 
shghtly  and  progressively  increased  as  the  operation  approaches 
the  end.  Tiio  rapidity  with  which  the  instrument  is  moved  over 
a  hne  should  vary  inversely  to  the  degree  to  which  it  is  heated,  the 
thickness  of  the  skin,  the  consistency  of  the  subcutaneous  tissues, 
and  also  the  stage  of  the  operation.  Generally,  the  movement  of 
the  cautery  should  be  accelerated  when  the  heat  is  greatest,  when 
the  sldn  is  thin,  when  the  tissues  underneath  are  hard,  and  when 
the  operation  is  nearly  completed. 

Another  important  rule  is  not  to  apply  too  heavy  a  pressure 
upon  the  cautery  when  moving  it  over  the  skin.  A  shght  pressm-e 
with  a  slow  movemeat  is  harmless  and  even  advantageous  at  the 
beginning  of  the  operation,  or  when  the  skin  is  thick,  but  it  be- 
comes dangerous  under  the  opposite  conditions  when  the  heat  of 
the  cautery  is  extreme.  In  such  a  case  a  true  incision  of  the  skin 
may  be  the  result.  Fu-ing  is  essentially  a  bloodless  operation 
even  when  severely  applied,  but  it  is  only  by  the  careful  observ- 
ance of  the  above  rules  that  hemorrhage  during  actual  cauteriza- 
tion can  be  avoided.  Its  appearance  during  the  ojieration  is,  we 
beheve,  the  result  of  inattention,  and  caused  by  too  hastily  raising 
the  heat  of  the  instrument,  or  more  often  by  excessive  pressure 
upon  it. 

The  observance  or  neglect  of  these  rules  will  demonstrate  the 
difference  between  scientific  and  unscientific  firing,  and  show  that 
while  one  is  true  scientific  surgery,  the  other  is  simply  burning 
the  skin.  The  first  is  applied  by  one  who  apjireciates  the  value 
of  the  residts  he  hopes  to  reahze,  while  the  other  merely  places  a 
hot  iron  in  contact  with  the  skin,  quite  ignorant  of  the  good  or 
evil  results  which  may  follow  the  act.  As  the  operation  progresses, 
changes  take  place  vipon  the  lines,  which  give  an  indication  of  the 
strength  of  the  firing.  These  objective  changes  consist  in  a  change 
of  color  in  the  hues,  and  an  accompanying  exudation  from  the  skin. 

In  the  first  degree,  or  light  firing,  the  Hues  are  not  deep,  and 


16G  OPERATIONS    ON    THE    SKIN    AND    CELLULAR    TISSUE. 

are  of  a  golden  yellow  tint,  having  only  a  few  isolated  drops  of 
serosity  at  their  sides,  the  dermis  not  being  extensible,  and  the 
skin  between  the  hnes  free  from  infiltration,  the  epidermis  can- 
not yet  be  scraped  with  the  finger  nail.  In  the  second  degree  or 
ordinary  firing,  the  hnes  are  of  a  lighter  color,  or  bright  yellow, 
the  drops  of  serosity  are  more  abundant,  the  dermis  is  more  ex- 
tensible, the  skin  between  the  Unes  is  thickened  with  infiltration, 
and  the  epidermis  is  easily  scraped  off.  In  the  third  degree,  or 
strong  Jiring,  the  hnes  have  a  hght  yellow  color,  the  dermis  is  so 
thinned  that  the  shghtest  traction  of  the  portions  between  the 
Hnes,  which  then  become  wider,  stretches  it,  the  serosity  is  abund- 
ant and  overruns  the  edges  of  the  hnes,  and  the  skin  between 
them  is  infiltrated  and  possibly  covered  with  small  phlyctenases  or 
bhsters.  To  proceed  further  will  be  to  produce  a  deep  burn, 
which  may  be  followed  with  serious  comphcations,  or  at  the  least, 
leave  large,  unsightly  cicatrices. 

The  length  of  time  required  to  produce  these  effects,  and  the 
frequency  of  the  apphcations  upon  a  given  region,  are  points  by 
no  means  easily  determined.  They  are  affected  by  many  contin- 
gencies, which  cannot  be  anticipated.  According  to  Fromage  de 
Feugrd,  a  cautery  heated  to  a  cherry  color  must  be  used  in  each 
line  from  ten  to  twelve  times  for  a  hght  firing,  and  from  fifteen  to 
twenty  for  more  serious  cases ;  but  Gourdon  considers  these  fig- 
ures too  high,  and  says  that  from  five  to  six  strokes  will  be  suffi- 
cient for  a  fii'ing  of  the  first  degree,  from  eight  to  nine  for  one  of 
the  second,  and  from  twelve  to  fifteen  for  the  third,  or  strong  fir- 
ing. But  these  figures  have  no  absolute  value.  The  number  of 
strokes  will  depend  upon  many  conditions,  such  as  the  heat  of  the 
instrument,  the  state  of  the  parts  and  the  dexterity  of  the  operator. 

The  effects  resulting  from  actual  transcurrent  cauterization 
may  be  divided  into  primitive  and  secondary. 

(a)  Primitive  effects.  —  The  inflammation  which  follows  the 
burning  manifests  itself  by  the  appearance  of  a  serous  exudation, 
the  serosity  being  in  the  form  of  small  drops,  in  greater  or  less 
abundance,  according  to  the  degree  of  the  cauterization.  This 
serosity  collects  between  and  at  the  bottom  of  the  lines,  and  con- 
tinues to  flow  for  from  twenty-four  to  forty  hours,  when  it  is  re- 
placed by  the  formation  of  crusts  or  scabs,  dry,  yellowish,  and  ir- 
regular, and  if  the  firing  has  been  light,  attached  to  the  bottom  or 
the  borders  of  the  hnes  ;  but  coveriner  the   entu'e  cauterized  sur- 


PRIMITIVE    EFFECTS. 


167 


face  between  the  lines,  as  well  as  at  tlie  bottom,  if  the  firing  has 
been  stronger.  These  crusts  of  dry  serosity  remain  adherent  for 
a  few  days  only,  and  from  the  sixth  day  to  the  eighth  they  begin 
to  separate,  but  the  dropping  off  of  the  cauterized  portions  of  the 
skin  requires  a  longer  time,  varying  according  to  the  degree  of  the 
firing.  In  the  first  degree  they  are  eUminated  by  the  formation 
of  a  new  layer  of  epidermis.  It  is  a  process  of  dry  desquamation 
by  which  they  are  exfoHated,  and  requires  from  two  to  three 
weeks  for  its  accompUshment.  In  the  second  degree,  when  the 
thickness  of  the  cauterized  tissue  is  greater,  the  scabs  proper  are 
more  adherent,  and  it  requu-es  a  process  nearly  aUied  to  one  of 
suppurative  expulsion,  which  may  consume  a  month  before  the  final 
sloughing  is  accompHshed.  In  the  third  degree,  a  regular  process 
of  suppiu'ation  is  necessary  for  the  removal  of  the  scabs,  and 
its  completion  will  require  a  period  of  not  less  than  five  or  six 
weeks. 

After  light  filing,  the  marks  left  are  scarcely  detectable ;  after 
the  second  degree,  the  hair  grows  over  the  lines,  but  in  an  irregu- 
lar way,  giving  a  somewhat  roughened  appearance  to  the  jJart, 
while  the  strong  firing  leaves  a  thick  and  callous  epidermis,  and 
therefore  a  serious  cicatrix.  Besides  these  first  and  direct  effects 
of  the  cautery,  there  are  others  which  ought  not  to  be  overlooked. 
About  the  parts  where  the  firing  has  been  applied,  the  skin  and 
the  subcutaneous  tissues  become  the  seat  of  extensive  inflamma- 
tion, accompanied  with  pain  and  swelling,  and  in  some  animals 
this  may  assume  a  severe  aspect.  The  swelling  may  extend  until 
it  involves  the  entire  extremity,  and  this  may  seriously  interfere 
with  the  act  of  locomotion.  It,  however,  subsides  and  disappears 
as  the  process  of  the  removal  of  the  scabs  advances,  and  when 
this  has  been  accomplished,  the  swelling  and  pain  will  also  have 
disappeared. 

(b)  Secondary  effects.  These  are  slow  in  their  development, 
and  cannot  be  easily  or  well  described,  and  they  vary  widely  ac- 
cording to  the  objects  for  which  the  firing  has  been  ap^Dhed.  It 
may  be  said,  however,  on  general  principles,  that  the  development 
of  secondary  effects  cannot  be  expected  except  after  a  consider- 
able lapse  of  time,  allowing  at  least  several  months,  and  in  any 
case,  only  long  after  the  objective  effects  have  entirely  disappeared. 

The  treatment  following  the  operation,  is  of  a  very  simjile 
character.     For  a    few  days,  and  until  the  secretion  upon  the 


168  OPERATIONS    OX    THE    SKIN    AND    CELLULAR    TISSUE. 

cauterized  parts  lias  dried  and  the  scabs  have  begun  to  slough, 
the  animal  must  be  restrained  from  lying  down,  and  biting  or 
rubbing  himself,  nor  must  this  vigilance  be  relaxed,  until  the 
dano-er  of  breaking  up  the  surface  of  the  wound  has  ceased,  with 
the  temptation  which  was  kept  up  by  the  continuation  of  the  ii-ri- 
tation,  with  the  dropping  off  of  the  scabs  and  of  the  cicatrization. 
There  is  no  necessity  for  interference  with  the  sloughing  of  the 
scabs,  or  occasion  for  impatience  to  see  them  removed.  After 
a  period  of  time,  which  varies  according  to  the  severity  of  the  op- 
eration, they  will  separate  spontaneously,  or  with  a  Httle  friction 
of  the  parts,  or  washing  with  tepid  water  and  soap. 

A  question  of  some  importance  in  connection  with  this  oper- 
ation, is  that  which  refers  to  the  use  of  oily  or  greasy  substances 
in  the  treatment  of  the  cauterized  surface.  In  times  past  this  was 
accounted  to  be  good  practice,  and  soothing  embrocations  were 
recommended  and  freely  employed,  but  this  treatment  has  become 
nearly,  if  not  whoUy,  obsolete.  At  the  most,  vesicating  prepara- 
tions are  considered  allowable,  but  even  these  only  under  special 
conditions,  as  when  the  cauterization  has  not  been  sufficiently 
strong.  This  practice  is  specially  prevalent  in  the  United  States, 
where  the  operations  of  firing  and  blistering  are  almost  always  as- 
sociated. This  combination  has  nothing  objectionable,  and  in  fact 
is  justified  by  the  apprehensions  and  opposition  existing  among 
Americans.  Yet  practitioners  must  always  remember,  that  if 
many  cases  where  firing  is  indicated  terminate  unsatisfactorily, 
after  both  firing  and  blistering,  it  is  because  the  true  and  local 
effects  of  the  cauterization,  by  ordinary  or  strong  firing,  have  not 
been  produced,  when  they  were  necessary  to  obtain  good  results. 
The  possibility  of  ugly  cicatrices  cannot  be  well  avoided  if  proper 
firing  is  to  be  depended  upon.  In  view  of  the  fact  that  the  effects 
of  firing  are  not  limited  to  those  which  visibly  and  immediately 
appear  on  the  surface  of  the  skin,  but  that  others  of  importance 
are  also  to  be  anticipated,  after  a  certain  time,  the  question  of  the 
duration  of  the  rest  necessary  for  the  patient  after  the  firing,  be- 
comes one  of  some  importance. 

All  written  authoi'ities  on  the  subject  agree  in  sajing,  that 
this  rest  must  be  a  long  one,  reckoning  it  by  months,  though  in 
some  instances  hght  exercise,  or  even  light  work,  may  be  allowed 
sooner.  Generally  speaking,  however,  the  surgeon  will  be  guided 
by  the  nature  and  history  of  his  case,  and  especially  by  the  extent 


SECONDAKY    EFFECTS.  1G9 

of  the  cauterization.  The  patient  will  of  com-se  requu-e  perma- 
nent and  absolute  rest  for  a  few  days,  or  until  the  serosity  and 
the  scabs  have  dried,  but  after  that  he  may  be  allowed  the  liberty 
of  a  box-stall,  or  of  the  j)asture,  without  interfering  with  the 
necessary  oversight  of  his  condition  and  progress.  There  are 
cases  where  moderate  walking  exercise  could  not  be  otherwise 
than  beneficial  in  its  effect  upon  the  final  result. 

Though,  as  we  have  said,  the  application  of  greasy  medica- 
ments may  not  be  recommended,  yet,  as  a  substitute  or  alterna- 
tive, bhstering  ointments  may  be  used  to  supplement  too  light  a 
firing.  It  is,  in  fact,  not  rare  to  find  it  necessary  to  follow  the 
firing  with  a  severe  bhstering  after  the  scabs  of  the  first  operation 
have  fallen  off.  If  this  is  done,  however,  it  must  not  be  until  the 
more  active  effects  have  diminished,  and  the  inflammation  has 
subsided. 

It  may  sometimes  become  necessary  to  solve  the  j)roblem  of 
the  duty  of  the  veterinarian  in  cases  where  an  animal  requires  the 
treatment  of  the  cautery  on  two  places  on  one  leg,  or  on  two  legs, 
or  perhaps  on  the  entire  four. 

Humane  feehng  alone  ought  to  furnish  a  sufficient  guide  in 
this  matter,  '^^^len  the  operation  is  not  only  in  itself  so  excep- 
tionally painful  diu-ing  its  performance,  but  is  followed  by  further 
suffering  arising  from  the  necessity  of  protecting  the  animal 
against  himself,  it  shovdd  be  considered  sufficient  to  inflict  the 
firings  singly,  and  after  the  first  infliction  to  repeat  the  torture 
only  after  a  respite  of  several  days.  On  this  point  we  differ  from 
the  opinion  expressed  by  some  Em^opean  writers,  and  cannot  dis- 
cover the  alleged  benefit  to  be  derived  from  any  extra  dispatch, 
in  the  absence  of  any  urgent  reason  for  considering  it  to  be  im- 
perative. Our  conviction  is  strong  that  one  firing  ought  not  to 
foUow  another  until  the  immediate  effects  of  the  first  have  sub- 
sided, and  the  animal  has  had  several  days  to  recuj)erate  from  the 
great  strain  he  has  been  compelled  to  endui-e. 

The  apj^Hcation  of  transcurrent  cauterization  is  very  often  in- 
dicated in  sohpeds,  and  we  borrow  from  Bouley  a  list  of  the  ordin- 
ary lesions  for  which  it  is  most  frequently  emj^loyed. 

A. — Eegions  of  the  ExTREivnTiES.  Coronet. — Indicated  against 
ringbones,  circular  periostitis  following  phalangeal  arthritis,  or 
deep  penetrating  wound  of  the  foot ;  exostosis  following  fractm-es. 
Apphed  in  lines,  parallel  to  the  axis  of  the  bone ;  not  too  near  to- 


170  OPEKATIONS    ON    THE    SKIN    AND    CELLULAR    TISSUE. 

gether,  to  avoid  sloughing  of  the  skin;  never  fire  beyond  the 
second  degree ;  avoid  bvirning  the  coronary  band.  Eesults  :  gen- 
erally efficacious,  but  necessary  to  rej^eat  it. 

Fetlock. — Articular  or  tendinous  windgaUs  ;  exostosis  ;  perios- 
titis after  sprains  or  arthritis ;  indm-ation  of  tendons ;  cold  infil- 
trations and  induration  of  ceUular  tissue;  knuckhng.  Apphed 
in  parallel  hues,  vertical  in  front  and  shghtly  oblique  behind.  Ee- 
sults :  not  so  satisfactory,  though  in  many  cases  favorable. 

Cannon. — Splints;  caUous  and  thick  tendons;  cold  infiltra- 
tion and  induration  of  cellular  tissue.  Applied  as  in  the  fetlock. 
Kesults:  generally  very  satisfactory;  second  firing  is  often  re- 
quired. 

Knee.  —  Articular  and  tendinous  synovial  dilatations  at  any 
part  of  the  joint ;  hygroma;  bony  deposits.  Applied  in  parallel 
hues,  vertical  in  front  or  oblique  on  the  lateral  faces.  Very  ad- 
vantageous for  synovial  dilatations  and  hygroma ;  less  so  in  exos- 
tosis. 

Forearm. — Bony  growths  of  any  kind ;  muscular  weakness, 
manifested  by  sprung  knee.  Lines  parallel  to  the  axis  of  the  re- 
gion.    Beneficial  for  exostosis ;  doubtful  in  the  other  cases. 

Elboio-joint. — Bony  deposits ;  dilatation  of  articular  sjoiovial 
sac.     In  parallel  lines.     Eesults  very  satisfactory. 

Arm. — Weakness  of  olecranon  muscles.  In  Hnes  parallel  to 
the  hairs.     Eesults  very  doubtful. 

Shoulder. — Muscular  atrojihy ;  paralysis ;  diseases  of  the  artic- 
ulation, dilatation  of  the  coraco-radialis  burste ;  lameness  of  tm- 
known  nature,  and  located  in  that  region,  may  involve  the  en- 
tire region,  or  it  may  only  cover  the  scapvdo-humeral  angle.  In 
the  first  case,  apphed  in  Hnes  parallel  to  the  direction  of  the 
hair,  extending  from  the  upper  to  the  lower  end  of  the  scapula, 
the  firing  has  an  oval  shape ;  in  the  second  case,  the  firing  is 
ch'cular,  and  forms  j)arts  of  two  parallel  hnes,  slightly  oblique  to 
each  other.  Generally  advantageous  in  atrophy  and  occult  lame- 
ness, doubtful  in  paralysis,  not  so  much  in  articular  or  tendinous 


Hock. — Articular  or  tendinous  tumors,  hygroma,  dilatation  of 
the  bursfe  of  the  extensors  of  the  cannon  and  flexors  of  the  foot, 
bony  growths,  peripheric  periostitis,  cold  infiltrations,  and  indura- 
tions of  cellular  tissue.  Drawings  of  the  firing  at  the  hock  vary, 
according  as  it  may  be  desired  to  fire  the  entire  joint  or  only  part. 


REGIONS    OF    THE    BODY.  171 

In  this  latter  case  it  is  applied  in  vertical  or  oblique  lines,  form- 
ing a  drawing  as  regular  as  j)Ossible.  In  the  former  case  two  ways 
are  recommended ;  in  one  the  sui'face  of  the  hock  is  divided  into 
halves  by  a  line  drawn  parallel  with  the  tendo- Achilles ;  all  lines 
back  of  this  one  are  parallel  with  it,  and  all  those  in  front  of  it 
are  parallel  with  the  front  of  the  hock,  and  therefore  shghtly 
obhque  to  the  others.  In  the  other  method,  a  line  is  drawn  from 
the  point  of  origin  of  the  tendo- Achilles  vertically  downward  to 
the  cannon  bone,  and  upon  this,  oblique,  feather-shaped  lines  are 
drawn  on  each  side.  Results,  generally  rather  favorable  in  all 
the  diseases  of  the  hock. 

Leg. — Bony  deposits,  rupture  of  the  cord  of  the  flexor  meta- 
tarsi; chronic  sweUing  applied  in  lines  parallel  to  the  region. 
Results,  very  advantageous. 

Stifle. — Dilatation  of  femoro-patellar  bursae,  exostosis  of  the 
patella,  luxation,  pain  remaining  after  bruises  or  wounds,  liga- 
mentous fistulas  of  old  standing.  AppHed  in  several  parallel  ver- 
tical lines  in  front,  and  on  each  side  oblique  to  them.  Results, 
almost  always  successful. 

Thigh  and  Goxo-femoral  Joint. — For  similar  lesions  to  those 
of  the  shoulder,  atrophy,  paralysis,  occult  lameness  ;  same  appli- 
cations.    Results  about  the  same. 

B.  — Regions  of  the  Body.  Loins. — "Weakness  of  vertebral 
column  due  to  paralysis  \  sprain  of  the  vertebral  column,  vertebral 
periostitis,  occult  pains.  Applied  in  lines  parallel  or  obhque  to 
the  median  line  of  the  body.     Results  generally  doubtful. 

Withers.  —  Chronic  cysts,  indurations  following  fistulous 
withers,  old  fistulas.  A  few  lines  parallel  with  the  vertebral  col- 
umn, the  others  oblique.     Results  almost  always  beneficial. 

Hibs. — Acute  or  chronic  pleuresy  and  pneumonia.  In  lines 
parallel  with  the  long  axis  of  the  ribs  ;  seldom  used,  the  results 
are  difficult  to  appreciate.  Principally  used  by  Nicholson  and 
Maclean  against  contagious  pleuro-pneumonia. 

Firing  on  the  Surface,  or  a  la  Gaulet. 
This  is  so  named  after  its  inventor.  The  mode  of  operation 
is  with  cauteries  which  have  their  border,  or  the  part  which  is 
apphed  to  the  skin  made  to  form  a  flat  or  slightly  convex  sur- 
face (instead  of  being  thin  and  sharp),  in  order  to  remedy  one 
of  the  principal  objections  to  ordinary  firing,   that  of  leaving 


172  OPERATIONS    ON    THE    SKIN    AND    CELLULAR    TISSUE. 

permanent  marks.  It  proposes  to  effect  this  by  throwing  upon 
the  surface  of  the  skin  an  even  radiation  of  heat.  The  descrip- 
tion given  by  Mr.  Gaulet  is  this:  "The  iron  being  heated  to 
nearly  a  cherry  color,  a  straight  line  is  made  in  the  principal 
direction  of  the  region  to  be  fired,  and  immediately  alongside  of 
it  another,  and  so  successively  \intil  the  entire  sm-face  is  covered. 
The  first  lines  are .  then  crossed,  transversely  or  obliquely,  by 
others,  which  perhaps  also  touch  each  other,  and  at  last,  in  order 
to  have  the  entire  surface  evenly  cauterized,  the  parts  which  have 
not  been  touched  in  tracing  the  original  lines  are  also  touched 
with  the  iron  which  then  retains  but  one-half  of  the  heat  it  pos- 
sessed at  first." 

*  *  *  "  After  twenty-four  hours,  or  perhaps  less,  an  inflamma- 
tory swelling  takes  place,  and  the  skin  is  covered  with  small 
bhsters  of  serosity ;  three  weeks  after,  the  crusts  which  have  fol- 
lowed begin  to  droj)  off,  and  the  hair  is  seen  growing  vmderneath 
them." 

According  to  Bouley,  this  method  cannot  be  substituted  for 
the  ordinary  cauterization.  If  applied  lightly,  its  effects  are  not 
more  severe  than  those  of  an  ordinary  blister ;  but  if  appUed  in  a 
severe  form,  it  is  liable  to  be  followed  by  the  sloughing  of  large 
portions  of  skin,  and  to  leave  behind  cicatrices  of  the  very  worst 
description.  It  has,  however,  in  the  hands  of  Mr.  Paul  Bouley, 
given  satisfactory  results  in  its  application  upon  the  stifle,  the 
point  of  the  shoulder,  and  the  cyst  of  the  withers,  and  with  Mr. 
Naudin,  in  the  treatment  of  chronic  swellings  of  the  extremities. 

Firing  in  Superficial  Points, 
This  form  of  cauterization  is  performed  with  instruments  of 
conical  or  ohvar  forms  (see  Fig.  201),  having  the  point  blunt  and 
rounded,  in  order  to  rest  on  the  skin  without  incising  or  penetrating 
it.  The  point  must  not  be  so  long  as  to  cool  off  too  rapidlj'-,  nor 
so  short  as  to  be  incapable  of  retaining  a  sufiicient  amount  of  heat. 
In  this  mode  of  firing,  the  poiats  or  dots  are  arranged  in  quintu- 
ples, a  first  series  of  points  being  marked  in  either  a  vertical, 
obhque  or  horizontal  line,  equidistant  from  each  other,  and  more 
or  less  close  according  to  the  indications ;  a  second  series  is 
marked  on  a  parallel  line,  at  a  distance  equal  to  that  which  sepa- 
rates the  dots  of  the  first  series,  and  placing  the  first  point  on  a 
line  with  the  middle  of  the  space  separating  the  dots  of  the  first 


FIRING    IN    SUPERFICIAL    POINTS. 


173 


series,  thus  alternating  the  appHcation  of  the  points  in  a  third  and 
fourth  series,  until  the  whole  surface  is  covered.  This  makes  a 
regular  drawing,  and  leaves  but  httle  blemish  afterward. 

The  rules  j)ertaining  to  the  appHcation  of  firing  in  straight 
lines  are  the  same  as  in  the  cauterization  in  superficial  points,  and 
they  apply  to  this  also,  but  we  beheve  this  is  to  be  better  indicated 
in  the  firing  of  small  surfaces,  for  bony  deposits,  ringbones, 
spHnts,  spavins  and  side-bones,  or  generally  in  the  treatment  of 
circumscribed  diseases. 


Fig.  205.— Firing  in  Dots  and  Points. 


Firing  in  points  is  always  more  effectual  than  that  in  straight 
lines,  and  being  exempt  from  the  danger  of  skin  sloughs,  it  always 
leaves  fewer  blemishes.  Moreover,  in  a  majority  of  cases,  it  can 
be  appHed  without  casting  the  patient.  These  are  points  which 
should  count  largely  in  its  favor.  The  principal  objection  to  be 
urged  against  it  is  the  greater  length  of  time  requu-ed  to  reahze 
the  full  measure  of  its  effects. 

Mr.  Prange  has  invented  a  mode  of  cauterization,  which  is  very 
similar  to  that  in  superficial  points,  but  differing  from  it  in  the 
fact  that  instead  of  points,  the  ordinary  flat  iron  is  used. 
It  is  cauterization  in  lines,  but  instead  of  being  long  and  made 
with  one  stroke  of  the  cautery,  they  are  divided  into  short  lines 
(see  Fig.  203),  also  arranged  in  quintuple,  like  the  dots  of  the 
point  firing.  This  method  has  not  found  favor  with  those  who 
have  experimented  with  it. 


174  opekations  on  the  skin  and  cellulak  tissue. 

Objective  Firing. 

In  this  mode  of  cauterization,  the  heat  is  transmitted,  not  by 
contact,  but  by  radiation.  It  is  a  process  rarely  resorted  to,  and 
when  it  is  used  it  is  more  as  an  adjunct  to  transcurrent  firing,  or 
as  a  simple  mode  of  revulsion.  It  consists  simply  in  bringing  the 
heated  iron  in  close  proximity  with  the  sarface  to  be  cauterized. 

Gaulet  is  reported  to  have  obtained  good  results  from  it  in 
the  treatment  of  ulcers,  grease  and  oj)hthalmia;  Leblanc  hi  chronic 
diseases  of  the  eye,  and  Laux  in  the  treatment  of  chronic  lameness 
of  the  thigh-  According  to  Gourdon,  it  is  indicated  for  the  arrest 
of  some  internal  hemorrhage  of  mucous  membranes ;  for  the  re- 
duction of  prolapsus  of  the  rectum  and  of  the  uterus ;  in  hernias ; 
to  stimulate  the  cicatrization  of  ulcers,  and  against  some  chronic 
inflammation  of  mucous  membranes,  of  the  conjunctiva,  the  pituit- 
ary membrane,  etc. 

The  cautery  used  by  Mercier  is  square,  oval  or  circular,  with 
the  surface,  which  is  to  face  the  skin,  unpohshed,  while  the  other 
is  smooth  and  polished,  a  disposition  designed  to  graduate  the 
firing  by  facilitating  the  radiation  of  the  heat  with  the  first,  and 
diminishing  it  with  the  second. 

The  special  aim  in  this  plan  is  to  avoid  the  formation  of  a  slough, 
and  to  attain  it  as  perfectly  as  possible,  the  firing  ought  to  be  so 
managed,  as  to  approximate  the  point  of  disorganization  as  nearly 
as  possible  without  reaching  it. 

In  operating,  the  surgeon,  after  satisfying  himself  of  the  con- 
dition of  the  skin  and  its  subjacent  connections,  moves  the  instru- 
ment to  and  fro  over  the  part,  carefully  avoiding  contact  with  the 
tegument.  If  the  hau-  burns  too  quickly,  it  indicates  an  excess  of 
heat,  or  that  the  instrument  is  too  near  the  surface.  The  heat 
should  be  gradually  increased  from  a  brown  to  a  cherry  red  color. 
The  duration  of  the  operation  dej)ends  on  the  condition  of  the 
skin.  When  the  epidermis  can  be  easily  scrajjed  with  the  finger- 
nail, or  is  raised  by  the  formation  of  small  bhsters,  and  the  fired 
surface  becomes  moist,  and  shows  little  drops  of  serosity,  and  the 
skin  becomes  thicker,  denser,  and  more  adherent  to  the  subjacent 
tissues,  the  evidence  is  present  that  the  proper  degree  of  firing  has 
been  reached. 

The  serosity  increases  immediately  after  the  operation,  and 
for  some  time  continues  to  flow,  until  the  surface  is  covered  with 


OBJECTIVE    FIRING. 


175 


its  dried  pellicles  or  crusts.  On  the  second  or  third  day  an  in- 
tiammatory  swelling  is  developed,  and  all  the  symptoms  of  ordin- 
ary firing  are  manifested,  and  after  three  or  four  weeks  the  reso- 
lution is  complete. 

If  the  firing  has  been  too  severe,  the  serous  secretion  becomes 
very  abundant,  and  the  inflammatory  swelling  increases  rapidly  and 
becomes  warm  and  painful.  Towards  the  fifth  or  sixth  day  the 
skin  becomes  black,  dries  up,  shrinks,  is  raised  in  large  patches, 
and  sloughs  off,  leaving  a  broad  sm-face,  covered  with  large  granu- 
lations, very  slow  to  cicatrize.  One  great  advantage  which  objec- 
tive cauterization  can  claim  over  ordinary  firing  is,  that  when  prop- 
erly performed,  it  leaves  no  blemish  whatsoever. 

Deep  Cauterization. 

The  cauterization  which  is  carried  beyond  the  thickness  of  the 
skin  and  penetrates  the  subcutaneous  structures,  receives  this 
designation. 

The  manner  in  which  the  cautery  is  inserted  into  the  tissues, 
and  the  length  of  time  it  is  allowed  to  remain  in  contact  with  them, 
have  justified  the  division  of  this  kind  of  cauterization  into  rapid 
deep,  and  inherent,  or  disorganizing  cauterization. 

Rapid  Deep  Cauterization. 

This  is  the  comparatively  recent  mode  known  as  needle  firing, 
inasmuch  as  it  consists  in  the  insertion  of  elongated  sharp,  needle 
shaped  cauteries,  heated  to  a  Hght  red.  Urbain  Leblanc  is  credited 
with  the  introduction  of  this  species  of  instrument  and  is  the 


--»<:S 


Fic.  206.— Abadie  Cautery. 


176 


OPEKATIONS    ON    THE    SKIN    AND    CELLULAB    TISSUE. 


author  of  the  first  report  of  its  results.  The  first  cautery  used 
by  Abadie  resembled  the  one  shown  in  Fig.  206.  In  using  it, 
the  animal  is  generally  secured  in  the  standing  position.  It  is 
appUed  at  a  Hght  red  heat  and  made  to  penetrate  through  aU  the 
tissues  down  to  the  subcutaneous  cellular  structure,  and  even 
through  the  synovial  sheaths.  Leblanc's  advice  is  to  make  the 
puncture  by  passing  the  iron  three  or  four  times  in  succession  in 
the  same  spot,  but  Abadie  completes  it  at  a  single  stroke.  This 
firing  is  foUowed  by  severe  inflammation  of  the  parts,  great  pain, 
swelling,  abundant  serous  secretion,  and  the  escape  of  synovial 
fluid.  It  has,  therefore,  powerfiil  revulsive  effects,  which,  how- 
ever, leave  scarcely  any  marks,  provided  only  the  finest  parts  of 
the  cautery  have  penetrated  the  tissues.  Otherwise  extensive  and 
fatal  suppurative  arthritis  may  be  looked  for.  This  cauterization 
is  indicated  in  cases  of  exostosis,  tendinous  swellings,  articular  and 
tendinous  synovial  dilatations,  splints,  ringbones,  spavin,  side- 
bones,  thick  tendons,  articular  and  tendinous  windgalls,  thorough 
pins,  blood  spavins,  etc. 

In  the  true  needle  cauterization  or  ignipuncture,  the  form  of 
the  cautery  is  changed,  but  in  all  other  respects  there  is  no 
diflerence. 

The  forms  of  the  needle  instruments  are  numerous,  and  of 
course  each  one  claims  some  sj)ecial  merit.  The  cautery  of 
Bianchi  and  that  of  Toucher  were  first  used,  and  these  were  fol- 
lowed by  the  instruments  in  which  the  point  or  needle  of  platinum 
could  be  changed.  There  were  others  of  more  comphcated  make, 
as  those  of  Bourguet,  SaUes,  Lagarrigue,  Vasselin  and  others,  or 


Pig.  207.— Bianchi  Cautery, 


RAPID    DEEP    CAUTERIZATION. 


177 


Fig.  208.— Pouchsr  Cautery. 

of  more  recent  invention  the  autothermic  cautery  of  Mr.  Ehret 
(Fig.  211). 

In  using  these  instruments,  whatever  may  be  the  position  of 
the  animal,  the  perforation  is  made  with  a  single  stroke  only,  the 
points  being  from  three-fourths  of  an  inch  to  an  inch  apart.  When 
operating  on  a  s}Tiovial  bursa,  the  needle  is  apjDlied  but  once ;  but 
if  the  skin  is  thick  and  indurated,  two  or  even  three  times  may  be 
necessary.  The  subsequent  application  of  a  stiff  blister  is  recom- 
mended by  some,  immediately  after  the  operation,  but  by  others 
after  an  interval  of  a  few  days.  This  firing  is  always  accompanied 
by  severe  inflammation  and  its  usual  phenomena,  but  it  generally 
subsides  after  a  few  days. 


178  OPEKATIONS    ON    THE    SKIN    AND    CELLULAR    TISSUE. 


0== 


Fig.  209.— Cautery  with  Changing  Points. 

No  severe  accidents  nre  likely  to  accompany  needle  firing. 
Small  liemorrhages  may  occur,  but  they  usually  cease  spontane- 
ously, though  it  must  be  admitted  that  fatal  cases  of  arthritis 
have  been  recorded,  which,  however,  are  avoidable  by  the  use  of 
proper  precautions.  The  attention  required  by  the  patient  after 
these  operations  do  not  vary  from  those  required  in  ordinary  cau- 
terization, although  the  duration  of  the  period  of  rest,  always 
necessary,  may  be  less  j^rolonged. 


Inheeent  Firing. 

This  differs  from  other  kinds,  in  being  performed  with  the 
cautery  heated  to  a  white  heat,  with  a  view  to  produce  more  or 
less  deep  disorganization,  according  to  the  needs  of  the  case. 
Sometimes  the  ajiphcation  is  made  upon  the  surface  only,  but  at 
others  at  a  required  depth  upon  the  deeper  tissues. 


INHERENT    FIRING. 


179 


Fig.  210.-Bourguet  Cautery.  Fig.  211.-Autothermlc  Cautery. 


180  OPERATIONS    ON    THE    SKIN    AND    CELLULAR    TISSUE. 

In  the  first  instance,  it  is  indicated  in  superficial  cutaneous  ulcers, 
in  wounds  indisposed  to  cicatrize ;  in  those  following  warts,  in  fun- 
goid growths,  in  cancerous,  melanotic  or  fibrous  tumors,  in  gan- 
grenous wounds  and  those  following  the  opening  of  a  cold  abscess ; 
in  fistula  due  to  caries  or  necrosis  of  bones,  tendons  or  ligaments, 
etc.  The  instruments  used  are  of  various  shapes :  round, 
olivary,  annular  or  culteUar.  They  are  applied  firmly  upon  the 
tissues,  and  held  in  place  for  a  few  seconds,  according  to  the  density 
of  the  parts  If  the  surface  is  wider  than  the  instruments,  the 
firing  must  be  done  by  sections,  applying  the  iron  in  detail  upon 
spots,  until  the  entire  surface  has  been  touched.  This  is  a  better 
method  than  that  of  rubbing  the  instrument  over  the  surface,  and 
renders  the  eftect  more  regular  and  uniform.  In  the  second 
degree,  or  the  cauterization  into  the  depth  of  the  tissues,  a  conical 
instrument  is  used  and  held  in  its  place  of  insertion  until  it  has 
lost  most  of  its  heat,  thus  reaching  whatever  depth  may  be  neces- 
sary. 

This  cauterization  is  indicated  against  anthracoid,  gangrenous, 
farcinous  and  cancerous  tumors  ;  in  wounds  of  a  virulent  or  veno- 
mous nature;  in  purulent  infiltrations  of  the  skin  or  of  the 
ceUiilar  tissue ;  in  caries  of  bones,  tendons,  cartilages  and  ligar- 
ments,  in  dental  caries,  in  indurated  tumors,  in  fungoid  growths, 
polypoid  granulations,  etc.  Renault  has  recommended  them  in 
the  treatment  of  the  large  sores  so  often  occurring  in  granular 
dermatitis. 

Subcutaneous  Cautebization, 

Otherwise  known  as  Neapolitan  cauterization,  or  "  a  la  Nan- 
zio,"  consists  in  the  appHcation  of  the  cautery  in  points  directly 
upon  the  muscular  structure,  exi30se<i  by  an  incision  made  through 
the  skin.  The  method  was  known  and  had  been  mentioned  by 
Ruini,  Solleysel,  Bourgelat,  Rejnial  and  others  in  more  or  less 
modified  and  varying  terms,  before  Mr.  de  Nanzio  called  the  at- 
tention of  the  profession  to  the  good  results  he  had  obtained  by 
it. 

Its  application  is  principally  efiicacious  in  the  treatment  of 
chronic  lameness  of  the  shoulder  or  of  the  coxo-femoral  joint. 
The  instruments  required  are  two  bistouries,  one  curved  and  one 
straight,  two  flat  tenaculums,  a  bull-dog  forceps,  scissors  and  an 
ordinary  oHvary  cautery.     De  Nanzio  thus  describes  the  opera- 


SUBCUTANEOUS    CAUTERIZATIOX. 


181 


Fig.  212.— Cauteries  of  Nancio. 

tion :  "  My  method  consists  in  making  an  incision  from  above 
downward  to  the  skin  covering  the  articulation,  the  location  of 
which  has  been  first  carefully  determined.  The  skin  is  then  dis- 
sected from  the  cellular  tissue,  and  the  flaps  enveloped  with  folds 
of  wet  cloth.  The  flat  tenaciilum  placed  on  each  border  of  the 
incision  keeps  it  open,  and  with  a  blunt  cautery,  not  too  red,  three 


Fig.  213.— Firing  k  la  Nancio. 


182  OPERATIONS    ON    THE    SKIN    AND    CELLULAR    TISSUE. 

or  four  points  are  applied  upon  the  seat  of  the  articulation, 
carefully  ascertaining  with  the  finger  the  point  which  the  cau- 
terization has  reached,  and  carefully  avoiding  the  opening  of  the 
joint." 

The  subsequent  treatment  is  simple,  and  consists  in  cleanli- 
ness, lotions  of  clear  or  slightly  astringent  water,  and  the  protec- 
tion of  the  wound  by  small  threads  of  oakum.  The  suppuration 
is  abundant  and  the  wound  ugly,  but  these  effects  are  soon  modi- 
fied, and  healing  is  followed  by  only  a  simple  linear  cicatrix.  Se- 
vere compHcations  have  been  recorded  as  sequelae  of  this  operation, 
but,  on  the  other  hand,  several  authors  have  spoken  of  it  in  very 
favorable  terms.  Our  own  experience  with  it  has  not  been  suffi- 
cient to  warrant  the  expression  of  a  confident  opinion. 

Cauterization  with  the  Thermo-Cautery. 

This  valuable  instrument,  the  invention  of  Doctor  Paquelin, 
has  only  within  a  comparatively  recent  period  been  added  defi- 
nitely to  the  armament  of  the  veterinarian.  The  original  instru- 
ment, as  used  in  human  surgery,  has  been  modified  by  the  inven- 
tor, and  as  now  sold  by  our  instrument  makers,  is  fully  adapted 


Fig.  214.— Paquelin  Cautery. 


CAUTERIZATION  WITH  THE  THERMO  CAUTERY.  183 


Fig.  215.— Paquelin  and  do  Place  Cautery. 

to  veterinary  practice,  and  possesses  points  of  superiority  over 
all  the  rest.  It  is  used  in  the  same  manner  and  under  the  same 
rules  as  other  modes  of  firing  ah*eady  considered,  but  while  its 
application  is  followed  by  similar  results,  it  possesses  also  many 
other  attendant  advantages,  which  render  it  a  valuable  addition  to 
our  operative  means. 

The  veterinary  cautery  of  Paquelin  and  de  Place  is  a  modifica- 
tion which  has  recently  been  introduced,  and  which  is  considered 
superior  to  the  original  instrument  by  those  who  have  used  it, 
principally  on  account  of  the  facility  with  which  an  even  degree 
of  temperature  is  kept  during  the  entire  length  of  the  operation. 
The  low  price  of  the  instrument  is  also  an  important  item  for  vet- 
erinary practice. 


Cauterization  in  Other  Animals. 

Firing  in  Large  Ruminants. — If  firing  is  not  as  commonly 
used  with  these  animals  as  with  solipeds,  it  is  not  because  its  ne- 
cessities are  less  frequent,  but  rather  from  economic  considera- 


184  OPERATIONS    ON    THE    SKIN    AND    CELLULAR    TISSUE. 

tions,  and  because  when  they  become  sei'iously  disabled,  instead 
of  subjecting  them  to  expensive  surgical  treatment,  a  wise  pecu- 
niary policy  consigns  them  to  the  shambles  where  they  may  still 
claim  an  unimpaired  market  value  ;  while  a  dead  horse  is  (in 
popular  estimation,  at  least)  held  to  be  of  no  particular  worth  in 
theory,  that  is,  whatever  may  be  the  unconscious  practice  of  un- 
inquiring-  eaters  of  "beef." 

It  has  been  applied,  however,  in  very  numerous  instances,  by 
Cruzel,  Roche,  Lubin,  Festal,  and  especially  by  Lafosse,  who  rec- 
ommended its  apphcation  in  articular,  muscular  and  tendinous 
lameness ;  for  synovial  dilatations,  bony  growths,  anchylosis  and 
luxations,  and  also  in  nervous  affections,  epilepsy,  paraplegia,  va- 
rious paralytic  cases  and  amaurosis. 

The  modus  operandi  is  the  same  as  that  already  described 
for  solipeds,  although  allowance  must  be  made  for  the  thickness 
of  the  skin,  which  requires  a  deeper  application,  and  necessitates 
the  repetition  of  the  firing  from  twelve  to  fifteen  times  in  the 
same  line,  in  order  to  obtain  an  ordinary  effect.  The  scabs  of  the 
firing  generally  separate  in  from  fifteen  to  twenty  days,  and  leave 
pale  rose  wounds,  followed  by  cicatrizations  with  a  smooth  sur- 
face. The  swelling  of  the  parts,  and  the  reactive  fever  following 
the  operation,  is  more  severe,  but  subsides  quite  readily.  The 
animal  must  be  prevented  from  rubbing  or  Hcking  himself  in 
order  to  obviate  the  danger  of  secondary  wounds  with  their  trou- 
blesome comphcations,  as  with  soHpeds. 

In  smaller  animals  cauterization  is  seldom  resorted  to.  In 
dogs,  however,  its  apphcation  is  sometimes  indicated  in  lameness 
of  the  elbow,  the  stifle,  and  even  the  hip  joints.  Superficial  firing 
by  points  has  been  advantageously  applied,  and  is  recommended 
by  Peuch  and  Toussaint. 

Accidents  or  Actual  Cauterization. 

To  a  great  extent,  the  accidents  and  failures  following  the  use 
of  the  cautery  result  from  the  non-observance  of  the  rules  estab- 
lished for  the  regulation  of  the  operation,  and  subsequent  care- 
less and  incompetent  nursing.  The  remedy  for  these  is  too  obvi- 
ous to  need  mention. 

(a)  Section  of  the  Skin. — This  is  a  very  common  accident,  usu- 
ally  chargeable  to  the  carelessness  or  incompetence  of  the  sur- 


ACCIDENTS    OF    ACTUAL    CAUTERIZATION.  1S5 

geon,  or  it  may  be  caused  by  the  use  of  too  heavy  or  too  sharp  an 
instrument,  or  to  an  excess  of  heat  or  of  pressure.  It  is  recog- 
nized by  the  separation  of  the  edges  of  the  wound,  and  the  ap- 
pearance at  the  bottom  of  the  lines  of  a  white  nacreous  stria, 
shown  by  the  subcutaneous  tissue.  There  is  no  remedy  for  this 
accident,  and  though  it  is  not  a  very  severe  lesion,  it  is  likely  to 
be  followed  by  rough  and  irregular  cicatrices. 

{b)  Hemorrhage. — We  have  said  that  firing  is  an  essentially 
bloodless  operation  if  properly  performed.  The  appearance,  there- 
fore, of  drops,  or  perhaps  of  a  small  stream  of  blood,  at  the  bot- 
tom of  the  lines  or  points,  and  perhaps  running  over  the  surface 
of  the  skin,  though  unattended  with  danger  and  not  likely  to  be 
injurious,  is,  at  the  least,  evidence  of  some  miscarriage  of  skill. 
If  it  arises  from  the  use  of  a  rough  or  too  sharp  an  instrument,  it 
can  be  readily  suppressed  by  searing  the  part,  or  applying  upon 
bleeding  vessels  another  cautery,  heated  a  little  in  excess  of  the 
first.  Sometimes  the  burning  of  a  small  quantity  of  pulverized 
resin,  or  of  a  small  lock  of  hair  in  the  bleeding  cavity,  will  have 
a  sufficient  hemostatic  effect,  and  simple  pressure  will  seldom,  if 
ever,  fail. 

(c)  Tearing  off  Scabs. — This  is  the  result  of  careless  and  in- 
secure dressing,  and  in  omitting  to  provide  elfective  safeguards 
for  preventing  the  patient  from  reaching  the  wound  with  his  own 
teeth,  or  rubbing  it  against  some  hard  object.  Suppurating 
wounds  of  various  dimensions  are  often  the  result  of  this  inad- 
vertency, i-equiring  careful  treatment,  and  sometimes  leaving  bad 
blemishes  to  be  regretted. 

{(l)  Sloughing  of  the  Skin  and  Subcutaneous  Tissues. — This 
accident  is  not  uncommon,  and  like  that  just  mentioned,  is  the 
effect  of  the  improper  application  of  the  cautery,  though  less  the 
effect  of  the  firing  than  of  burning  the  parts,  and  it  is  character- 
ized by  all  the  conditions  of  ordinary  burn  wounds.  Among 
specific  causes,  however,  may  be  mentioned  too  strong  a  firing, 
or  firing  with  lines  too  near  together,  or  touching  each  other  at 
some  angle,  or  in  crossing,  or  when  too  large  an  iron  is  used,  or 
one  brought  to  a  radiating  heat,  or  too  high  a  temperature ;  or 
when  greasy  substances  have  been  applied  in  the  Hnes,  or  the  skin 
submitted  to  long  frictions.  AH  these  causes  tend  to  the  disorgan- 
ization of  the  skin,  with  mortification  and  sloughing,  and  its  separa- 
tion in  large  patches,  leaving  after  healing,  broad,  ugly  blemishes. 


186  OPERATIONS    ON    THE    SKIN    AND    CELLULA.K    TISSUE. 

(e)  JBad  cicatrices. — Though,  firing,  however  carefully  apj)lied, 
will  always  be  followed  by  legible  marks,  there  are  cases  in  which 
bad,  callous  cicatrices  form  a  positive  and  repulsive  life-long  dis- 
figurement of  the  animal.  In  the  most  aggravated  forms  of  the  ac- 
cidents enumerated,  there  are  circumstances  which  particularly 
favor  their  occurrence.  Among  these  may  be  regarded  the  thin- 
ness and  sensitiveness  of  the  skin,  the  interference  of  the  animal 
himself,  by  rubbing  and  biting,  and  an  excessive  suppurative 
action  accompanying  the  falling  off  of  the  scabs.  No  treatment 
is  known  that  can  be  made  effective  against  these  lesions,  but  it 
is  satisfactory  to  know  that  they  do  not  inhere  in  the  operation, 
and  are  preventable  in  the  exercise  of  proper  skill  by  the  operator, 
and  attention  by  the  nurse. 

EXUTORIES. 

An  executory  is  any  therapeutic  agency  or  means  the  effect  of 
which  is  to  promote  the  formation  of  purulent  matter,  and  to 
sustain  the  suppurative  process  after  it  has  been  established. 
Some  exutories  have  no  sj^ecial  intrinsic  quahties,  and  simply 
take  effect  in  the  manner  characteristic  of  foreign  bodies  when 
lodged  in  any  portion  of  the  system ;  while,  on  the  other  hand, 
some  of  them  possess  specific  properties  by  which  a  special  irrita- 
tion is  produced  in  the  tissues  with  which  they  come  in  contact. 
The  various  forms  of  seton  are  included  in  the  first  class; 
the  trochiscus,  bhsters,  however  composed,  the  moxa,  and  the 
actual  cautery  belong  to  the  second.  But  while  the  fact  of 
the  utilization  of  the  operation  is  as  old  as  the  practice  of 
medicine  itself,  the  modes  of  application  and  the  materials  used 
have  varied  considerably  during  various  epochs.  The  use  of  the 
root  of  black  hellebore  was  recommended  for  diseases  of  the  ears 
in  large  ruminants,  and  also  in  the  treatment  of  diseases  of  the 
chest,  or  in  oedematous  swellings  of  the  abdomen. 

At  a  later  period,  the  actual  cautery  found  its  advocates  in 
the  treatment  of  tetanus.  The  introduction  of  feathers,  or  long 
quills  under  the  skin,  in  the  treatment  of  old  shoulder  lameness, 
followed,  and  in  some  parts  of  the  world  this  practice  has  not  yet 
been  wholly  abandoned.  Sometimes  the  feathers  were  used 
alone,  and  in  other  cases  air  was  blown  into  the  cellular  tissue 
under  the  skin,  in  the  parts  where  they  were  to  be  placed.     The 


EXUTORIES.  187 

first  description  of  the  seton  and  its  effects  was  given  by  Markam, 
in  1556.  But  even  after  that  date  we  read  of  the  use  of  irri- 
tating soft  pencils,  or  candles  composed  of  various  ointments, 
melted  or  mixed  together,  and  introduced  under  the  skin,  incised 
for  the  purpose,  and  more  or  less  massed  or  bruised  with  some 
hard  substance.  But  the  accidents  which  were  apt  to  accompany 
some  of  these  energetic  forms  of  treatment  were  of  so  serious 
a  nature  that  they  gradually  fell  into  disuse,  and  to-day  this  class 
of  principal  exutories  includes  only  the  seton  in  its  various  forms, 
the  trochiscus  and  the  vesicating  preparations. 

Exutories  act  as  counter  irritants,  resolvents,  and  alteratives. 
The  irritation  which  follows  their  contact  with  the  living  tissues 
excites  the  purulent  secretions,  and  the  activity  in  the  process  of 
interstitial  resorption,  which  they  stimulate,  render  their  adoption 
and  frequent  use  a  source  of  much  benefit  and  great  satisfaction 
to  the  veterinary  practitioner.  The  list  of  ailments  in  which 
their  value  is  manifest  and  unquestioned  is  a  long  one,  and  com- 
prehends affections  of  the  chest,  catarrhal  inflammation  of  the 
air  passages,  and  affections  of  the  abdominal  organs,  with  those 
of  the  eye,  and  in  dogs  of  the  ear.  They  stimulate  the  resolution 
of  local  afiections  having  a  tendency  to  chronicity,  for  example, 
oedematous  swellings  of  the  extremities,  and  they  are  frequently 
indicated  in  diseases  of  the  locomotory  apparatus,  in  certain  af- 
fections of  joints,  and  in  rheumatic  lameness,  and  also  to  excite 
the  resolution  of  soft  tumors,  especially  those  of  the  synovial 
structures.  The  most  ehgible  of  the  forms  in  which  exutories 
are  prepared,  especially  when  they  are  designed  to  act  as  a  means 
of  drainage,  or  to  prevent  the  accumulation  of  pus  in  anfractuous 
cavities,  is  the  seton.  It  is  recommended  in  nervous  affections 
and  in  paralysis,  and  also  for  the  relief  of  atrophied  regions,  and, 
according  to  Bouley,  it  may  often  become  a  means  of  diagnosis, 
as  well  as  of  prognosis. 

In  an  acute  disease  having  a  tendency  towards  recovery,  a 
seton  will  have  an  ii'ritating  effect,  and  give  rise  to  a  phlegmous 
swelling  about  its  tract,  while  in  the  same  disease,  if  the  tendency 
be  toward  a  fatal  termination,  the  artificial  suppuration  which  it 
causes  will  soon  cease  to  flow,  and  the  tract  will  remain  compara- 
tively dry. 

There  have  been  those  who  have  made  the  seton  a  prophylac- 
tic agent,  or  insurance  institution,  to  be  made  use  of  at  certain 


188  OPERATIONS    ON    THE    SKIN    AND    CELLULAR    TISSUE. 

special  periods  or  seasons  of  the  year,  and  have  thus  invented  the 
seton  of  prevention  or  of  precauiion,  but  without  satisfactorily 
demonstrating  what  is  to  be  prevented,  or  what  anticipated.  The 
theory,  if  any,  in  which  such  an  assumption  originates  cannot  be 
certified,  and  honest  veteriaarians  cannot  themselves  identify  it 
with  such  a  practice  or  pretext. 

If  exutories  are  a  frequent  resort,  and  are  highly  appreciated 
in  veterinary  surgery,  and  their  general  use  is  commonly  unat- 
tended with  danger,  yet  they  are  not  always  so  absolutely  harm- 
less that  they  may  be  trifled  with,  and  prescribed  without  due 
consideration  of  the  peculiar  conditions  under  which  their  use  is 
contra-indicated.  It  cannot  be  rationally  supposed  that  the 
potency  to  which  they  owe  their  beneficial  effect  when  rightly 
du-ected  is  to  vanish  when  it  is  erroneously  applied,  and  that  it 
can  be  made  innocuous  by  misdirecting  it.  Animals  debilitated  by 
hea\'y  work  or  by  disease ;  those  affected  with  chronic  organic 
ailments;  those  threatened  with  eruptive  diseases,  or  suffering 
with  septic  complaints;  none  of  these  are  fit  subjects  for  the 
application  of  exutories. 

SETONS. 

A  seton  is  a  form  of  exutory  which  consists  in  the  introduction 
of  a  foreign  substance  under  the  skin,  ordinarily  a  band  of  linen 
tape,  or  a  leather  ring.  The  former  is  known  as  the  tape  seton, 
while  the  second  is  more  appropriately  termed  a  rowel. 

Tape  Seton. 

This  is  usually  merely  a  piece  of  clean,  white  tape,  of  suitable 
width  and  length  as  required  by  the  case.  In  some  circumstances, 
however,  cords  or  braids  of  lint  or  horse-hair  are  substituted. 
The  seton  may  either  be  introduced  under  the  skin  alone  and 
dry,  or  it  may  be  saturated  with  some  irritating  fluid,  or  covered 
with  a  stimulating  ointment,  to  increase  its  effect  and  promote  the 
purulent  secretion.  The  operator  must  not  fail  to  allow  a  suffi- 
cient length  to  securely  tie  the  ends  which  pass  out  at  the  two 
openings  of  the  tract  through  which  it  is  drawn.  Yet  they  are 
not  always  secured  by  an  ordinary  knot,  but  are  quite  generally 
united  by  a  species  of  twist  upon  their  extremities,  which  can  be 
readily  loosened  when  it  becomes  necessary.  This  knot  must  be 
sufficiently  wide  and  strong  to  prevent  it  from  sHpping  thi-ough 


SETON  NEEDLES. 


189 


Fig.  316.— Seton  Knots. 

the  incision.  In  some  cases,  instead  of  making  a  knot  on  tlie  tape, 
small  wooden  pins  are  secured  at  the  extremities,  and  answer  the 
same  purpose. 

The  essential  instrument  required  to  apply  a  seton  is  the 
pecuHar  needle  known  as  the  seton  needle.  It  is,  of  course,  made 
various  lengths,  some  consisting  of  but  a  single  piece  (Fig.  218); 


I 


i 


Pig.  sir. 


Fig.  218.  Fig.  219. 

SETON  NEEDLES. 


Fig.  220. 


Fig.  221. 


190  OPERATIONS    ON    THE    SKIN    AND    CELLULAR    TISSUE. 

while  others  are  in  two  or  three  sections,  connected  by  screw  joints 
(Figs.  219,  220,  221),  and  in  some  few  instances  fitted  to  handles 
(Fig.  217).  But  however  they  may  otherwise  vary,  they  are  in 
the  general  form  of  a  stiff,  iron  rod,  with  one  lanceolated  extrem- 
ity, both  edges  sharp,  and  a  large  eye  at  the  blunt  end  to  receive 
the  tape.  The  lanceolated  portion  is  slightly  curved  on  the  flat 
side.  There  are  also  other  forms  designed  for  sjDecial  objects, 
among  which  may  be  mentioned  one  which  is  used  for  passing  a 
seton  through  the  frog  of  the  foot,  and  is  therefore  known  as  the 
frogf  seton-needle. 


Fig.  222.— Frog  Seton  Needle. 

For  small  animals,  such  as  the  dog,  the  smaller  sized  straight 
needles  are  often  suitable,  and  the  one  which  is  used  for  making 
the  quill-suture  is  very  convenient. 

Besides  the  seton  needle  proper,  in  its  authorized  and  usual 
patterns,  occasions  sometimes  occur  when  to  meet  special  requii-e- 
ments,  a  straight,  pointed  bistoiuy  and  a  pair  of  scissors  are  re- 
quired as  adjiincts. 


Fig.  223.— Quill  Suture  Needle. 

The  operation  of  setoning  is  comparatively  a  bloodless  one, 
and  the  division  of  the  cellular  tissues  through  which  the  needle 
passes  is  very  often  made  without  any  hemorrhage.  Yet  there 
are  regions  where  more  or  less  blood  may  subsequently  escape. 
A  region,  therefore,  where  the  cellular  tissue  is  abundant  and 
loose,  is  that  which  is  most  favorable  for  the  introduction  of 
setons. 

The  modus  operandi  is  simple.  The  hau'  must  be  closely 
cHpped  from  about  the  points  selected  for  the  two  preHminary 
punctures,  one  for  the  entrance  and  one  for  the  exit  of  the  needle, 


SETON    NEEDLES.  191 

uud  the  patient  must  be  properly  secured.  Certain  nervous  ani- 
mals may  oblige  the  surgeon  to  place  them  in  the  recumbent  posi- 
tion, but  our  experience  has  taught  us  that  the  cases  in  which  this 
is  necessary  are  very  excej)tional,  and  that  in  the  great  majority 
of  operations,  the  simplest  means  of  restraint,  a  twitch,  with  the 
raising  and  securing  of  one  or  two  of  the  extremities,  is  all  that  is 
requii'ed. 

The  appHcation  of  local  anesthesia,  so  far  as  it  may  be  practi- 
cable, is  also  a  measiu'e  which  is  in  all  respects  judicious  and  com- 
mendable. With  the  spraying  aj^paratus,  any  part  of  the  body 
can  be  reached  with  great  facility. 

In  introducing  the  needle,  many  veterinarians  pass  it  du-ectly 
tln'ough  the  skin,  which  is  raised  in  a  fold,  and  drawn  away  as  far 
as  possible  from  the  deeper  tissues.  This  maybe  readily  practica- 
ble in  regions  where  the  cellular  tissue  is  very  loose  and  abundant, 
as  under  the  chest ;  but  it  is  much  less  so,  and  more  dangerous 
where  the  skin  is  thick,  and  the  subjacent  connective  tissue  is  de- 
ficient or  scant,  and  especially  if  the  edges  and  point  of  the 
needle  are  not  perfectly  sharp. 

For  this  reason  the  method  preferred  by  many  is  more  judi- 
cious, of  making  an  incision  with  the  straight  bistoury  through 
the  skin  at  each  of  the  two  extremities  of  the  proposed  tract 
through  which  it  is  intended  to  pass  the  seton.  The  manipulation 
is  sufficiently  easy  and  simple,  the  operator  holding  the  skin  in  a 
fold  with  one  hand,  while  with  the  other  he  guides  the  needle 
under  the  skin  and  parallel  with  it,  through  the  cellular  tissue, 
entering  through  one  of  the  punctures  made  with  the  bistoury, 
and  emerging  through  the  other.  The  point  most  important  to 
observe  here  is  that  of  so  guiding  the  needle  in  its  motion  that  it 
shall  neither  plunge  into  the  deeper  tissues  nor  emerge  outwardly 
at  the  wrong  place.  At  this  point  the  scissors  may  be  utihzed  by 
laying  blades  flatwise  over  the  place  of  exit,  and  pressing  down 
the  svirface.  Directions  are  sometimes  given,  as  the  next  stejD,  to 
insert  the  tape  into  the  eye  of  the  needle,  but  it  would  seem  that 
the  safer  plan  would  be  to  have  the  tape  already  in  place  when 
the  needle  is  introduced.  After  the  tape  has  been  drawn  through, 
and  the  needle  disengaged,  the  next  and  final  step  is  either  to 
iinite  the  ends  of  the  seton  by  a  knot,  or,  without  tying,  to  secure 
them  separately  by  the  twisting  or  plaiting  already  described,  and 
leave  them  free. 


192  OPERATIONS    ON    THE    SKIN    AND    CELLULAR    TISSUE. 

« 

The  first  effects  following  the  application  of  a  seton  are  those 
met  with  in  a  majority  of  ordinary  wounds ;  more  or  less  swelling 
and  inflammation,  followed  by  an  access  of  the  suppurative  pro- 
cess. At  the  points  of  insertion  and  exit  of  the  needle,  a  certain 
amount  of  hemorrhage  takes  place,  generally  of  no  importance, 
and  subsiding  without  interference,  and  this  is  succeeded  by  a 
swelling  along  the  braid  of  the  seton,  at  first  more  or  less  diffusi- 
ble, with  a  tendency  to  increase  during  the  first  forty-eight  hours 
but  then  becoming  more  defined.  In  the  beginning,  and  for  the 
first  two  days,  there  is  a  flow  of  a  thin  serosity  from  the  opening 
of  the  seton,  which  gradually  assumes  the  character  of  suppura- 
tion of  good  quality  in  the  shape  of  creamy,  laudable  pus.  Up  to 
this  period  the  seton  needs  no  attention,  and  should  be  left  with- 
out interference,  to  exhibit  the  natural  traumatic  effect  of  its 
presence.  Although  it  is  desirable  to  have  the  suppuration  well 
estabhshed  and  flowing  freely,  it  must  not  be  permitted  to  accumu- 
late in  the  tract,  and  should  be  subjected  once  or  twice  a  day  to 
gentle  pressure  along  the  entire  length  of  the  seton,  to  expel  the 
least  portion  of  purulent  matter  present.  At  the  same  time,  such  a 
pressure  as  would  be  hkely  to  crush  the  granulations  of  the  wound 
and  thus  excite  small  hemorrhages,  must  be  avoided. 

The  cleaning  and  washing  of  the  oj)enings  of  the  seton,  and  of 
the  tape  itself,  must  be  carefully  and  strictly  performed  as  often 
as  the  abundance  of  the  discharge  requires  it.  It  should  be  sys- 
tematically attended  to,  not  less  than  once  or  twice  daily,  at  the 
least.  Precautions  must  be  taken  to  prevent  the  animal  from 
biting  and  pulling  off  the  seton,  and  yet  this  accident  is  very 
possible,  and  it  may  frequently  become  necessary  to  replace  it.  In 
that  case  the  needle  should  be  introduced  by  its  blunt  end,  with 
the  new  tape  previously  inserted  in  the  eye.  At  times  it  becomes 
necessary  for  other  reasons  to  renew  the  seton.  A  feasible  way 
to  effect  this  will  be  to  attach  the  old  tape  to  the  new,  and  draw 
out  the  former  by  means  of  the  latter.  The  length  of  time  a 
seton  ought  to  be  allowed  to  remain  in  place  varies  according  to 
circumstances,  extending  to  a  period  of  from  thi'ee  to  four  weeks, 
or  even  longer. 

"When  the  time  has  arrived  for  the  discontinuance  of  a  seton, 
if  more  than  one  have  accomplished  their  purpose  and  had  the 
desired  effect,  they  ought  not  to  be  all  removed  at  the  same  time, 
but  singly,  and  with  an  interval  between  them.     Nor  must  the 


APPLICATION  OF  TAPE  SETONS.  103 

wound  be  neglected  because  the  seton  has  been  removed,  but  it 
must  receive  needed  attention  for  several  days.  The  openings  of 
the  tract  will  still  require  cleaning,  and  the  residue  of  the  pus  will 
still  requu'e  the  aid  of  pressure  to  effect  the  final  emptying  of  the 
wound. 

Tape  setons  are  applied  upon  all  parts  of  the  body,  but  more 
frequently,  of  course,  in  regions  where  their  therapeutic  effects  are 
most  needed,  for  which  reason  they  will  be  most  commonly 
found  on  the  breast,  the  ribs,  the  shoulder,  the  hip,  the  thigh,  the 
stifle,  the  abdomen,  the  neck,  the  cheeks  and  the  foot. 

(a)  The  Breast. — This  is  a  very  common  location  for  the  setons. 
In  inserting  it  the  animal  is  secured  in  the  usual  w\ay,  but  to  pre- 
vent his  striking  the  operator  with  his  fore  feet  it  will  be  necessary 
to  have  one  of  his  hind  legs  raised  and  firmly  held.  If  there  is 
but  one  seton  it  must  be  introduced  on  the  median  line ;  if  two, 
one  on  each  side  of  it. 

The  position  assumed  by  the  operator  varies,  according  to  the 
ability  he  possesses,  and  the  hand  with  which  he  operates.  If 
ambidexter,  and  but  a  single  seton  is  to  be  introduced,  he  can 
operate  from  either  side  of  the  animal,  and  if  two  are  to  be  insert- 
ed, he  can  change  the  needle  from  one  hand  to  the  other,  to  suit 
his  convenience,  without  change  of  position. 

This  seton  is  to  extend  from  the  anterior  extremity  of  the 
sternum  downward  and  backward,  under  the  chest,  or  between 
the  fore  legs,  backward  beyond  the  elbow.  When  the  incision  of 
exit  has  been  made,  and  the  tape  introduced  into  the  eye  of  the 
needle,  the  instrument  must  be  drawn  away  in  the  direction  op- 
posite to  that  in  which  it  was  introduced,  to  avoid  the  possibiHty 
of  doing  injury  with  the  point  or  the  edges. 

{Jjl)  On  the  Ribs  or  the  Chest. — Setons  are  used  in  these 
regions  for  the  treatment  of  diseases  of  the  thoracic  organs. 
Sometimes  as  many  as  three  are  applied,  either  on  one  or  both 
sides  of  the  chest.  They  should  be  placed  in  a  slightly  oblique 
dii'ection  from  before  backward  and  from  above  downward, 
beginning  about  the  middle  of  the  side  of  the  thorax,  and  ex- 
tending as  far  as  the  lower  border  of  the  chest,  occupying,  there- 
fore, the  lower  half  of  the  thoracic  cavity.  The  manner  of  insert- 
ing the  seton  in  the  tract  made  by  an  incision  with  a  bistoury 
through  a  fold  of  the  skin  has  been  already  described,  and  a 
repetition  in  minute  detaU  becomes  iinnecessary. 


194  OPERATIONS    ON    THE    SKIN    AND    CELLULAR    TISSUE. 

Care  must  be  taken  wliile  operating  in  tliis  region  to  avoid 
wounding  the  spur  vein,  wliicli  can  be  done  by  raising  the  skin 
well  from  it  when  the  point  of  the  instrument  has  reached  its 
course,  by  which  movement  the  needle  passes  outside  of  the 
vein  and  can  be  brought  outside  on  the  inferior  border  of  the 
thorax.  The  tape  is  then  placed  in  the  eye  of  either  the  needle 
or  the  blade  as  already  frequently  described.  Our  own  practice 
is  to  secure  the  taj^e  through  the  eye  of  the  blade,  and  draw  the 
tape  into  position  by  removing  the  needle  from  below  upward, 
considering  this  j^lan  to  be  both  more  convenient  and  less  dan- 
gerous. 

(c)  At  the  Shoulder. — Setons  are  often  applied  in  this  region 
against  lameness  of  old  standing;  at  times  only  one,  at  others 
two,  or  even  more,  according  to  the  extent  and  location  of  the  dis- 
eased region.  When  aj)plying  more  than  one,  they  are  commonly 
placed  parallel  with  each  other.  Many  practitioners  place  them 
crossing  each  other,  meeting  in  the  middle  of  their  length,  with 
then-  point  of  meeting  on  a  level  with  the  center  of  the  scapulo- 
humeral joint.  In  placing  them,  the  compound,  or  three-jointed 
needle,  somewhat  flexible  (already  described),  will  be  necessary, 
as  being  capable  of  adapting  itself  as  much  as  possible  to  the 
convexity  of  the  joint.  Some  care  is  required  in  the  selection  of 
a  proper  place  for  the  puncture,  and  the  animal  must  be  kept  in 
the  standing  position  as  much  under  restraint  as  possible. 

There  is  probably  no  special  rule  for  the  location  and  direction 
in  which  setons  should  be  applied,  the  discretion  of  the  operator, 
in  many  cases,  furnishing  the  only  guide.  This  is  well  illustrated 
in  the  application  of  the  monstrous  "  seton  a  la  Gaulet^^  so  called 
from  its  inventor,  and  which  consisted  in  surrounding  the  entii-e 
scapular  surface  with  one  immense  seton,  beginning  at  the  cer^dcal 
angle  of  the  scaiDula,  running  along  its  anterior  border  to  a  point 
below  the  shoulder,  passing  in  front  of  the  breast  to  the  axilla, 
through  that  region,  horizontally  back  on  a  level  with  the  elbow, 
to  return  outward  and  then  upward  to  the  dorsal  angle  of  the 
scapula,  where  it  ended.  This  form  of  exutory  is  no  longer  toler- 
ated, the  dangers  attending  it,  from  the  severe  and  exhausting 
drainage  of  the  organism  having  brought  it  into  discredit,  with 
the  resvdt  of  its  dismissal  from  general  practice. 

A  seton  at  the  shoulder  requu-es  special  protection  from  the 
animal,  by  means  of  the  cradle  or  the  side  bars,  its  location 


APPLICATION  OF  TAPE  SETONS.  195 

making  it  too  easily  accessible  to  his  teeth  to  be  suffered  to  re- 
main long  in  place  without  such  a  defence. 

(d)  Setoii  at  the  Ilijy-J'oint. — Lameness  of  this  region  is  fre- 
quently treated  by  the  tape  seton,  the  conditions  of  their  applica- 
tion being  nearly  identical  with  those  reqviired  when  the  shoulder 
is  the  region  involved.  They  are  placed,  whether  single  or  dou- 
ble, directly  over  the  articulation,  or  crossing  each  other  in  the 
X  form,  and  also  over  the  center  of  the  joint ;  and  care  must  be 
taken  that  they  are  not  inserted  so  obliquely  as  to  interfere  with 
the  free  flow  of  the  pus.  A  needle  similar  to  that  used  with  the 
shoulder  will  be  found  convenient,  and  for  a  similar  reason,  the 
thickness  of  the  skin,  and  the  closeness  of  its  connection  with  the 
sub-tissues,  will  render  necessary  the  preliminary  incisions  with 
the  bistoury  to  facihtate  the  entrance  of  the  needle  ;  and  the  con- 
trol of  the  animal,  as  he  is  to  be  treated  on  his  feet,  should  be 
secured  by  supplementing  the  restraint  of  the  twitch  with  that  of 
the  side  lines,  and  raising  one  of  the  hind  legs. 

(e)  Setons  at  the  Thigh.  —  These  are  prescribed  in  chronic 
swelling  of  the  hind  legs.  The  region  they  should  cover  extends 
from  a  level  with  a  point  a  little  below  the  inside  of  the  ischial 
tuberosity  to  the  superior  third  of  the  shank,  and  they  should  be 
placed  in  a  slightly  obUque  direction  from  without  inward.  It  is 
necessary  while  operating  here,  as  in  the  hip-joint,  to  have  the 
animal  well  secured,  and  not  only  the  twitch  and  the  side-lines, 
but  sometimes  the  raising  of  one  of  the  fore  foot  will  be  required  ; 
as  of  all  setons,  this  is  probably  the  most  painful  to  insert,  in  con- 
sequence of  the  division  of  branches  of  the  sciatic  nerves,  which 
He  in  the  course  of  the  needle.  The  steps  of  the  operation  do 
not  in  any  way  vary  from  those  in  other  regions,  and  therefore  do 
not  call  for  a  redescription  excepting  perhaps  to  specify  that  in 
placing  the  tape  the  convexity  of  the  blade  must  be  turned  in- 
wardly, and  an  assistant  will  be  needed  to  hold  the  tail  aside.  The 
tying  of  the  tail  to  the  surcingle  on  the  opposite  side  of  the  body 
will  prevent  its  becoming  soiled  with  the  discharge  of  the  seton, 
and  render  the  subsequent  care  of  the  patient  easier. 

{f)  Setons  at  the  Stifle. — This  seton  is  recommended  by  Peuch 
and  Toussaint  in  lameness  of  that  region  which  has  resisted  vesi- 
cating liniments  and  blistering  applications.  They  recommend 
the  recumbent  position  for  the  safety  of  the  operator.  A  convex 
bistoury  and  the  ordinary  seton-needle  are  required.     The  animal 


196  OPERATIONS    ON    THE    SKIN    AND    CELLULAR    TISSUE. 

while  lying  down  has  his  hind  leg  extended  by  the  traction  made 
upon  it  by  assistants  with  a  rope.  An  incision  is  made  above 
with  the  bistoury,  and  the  needle  introduced  through  it,  it  is 
pushed  downward  in  front  of  the  joint,  carefully  i-aising  the  skin 
as  it  progresses,  to  avoid  injury  of  the  femoro-patellar  articulation 

(</)  Seton  on  the  Abdomen. — This  seton  is  both  difficult  and 
dangerous  to  apply  in  the  standing  position,  and,  therefore,  unless 
the  animal  is  very  carefully  secured,  and  the  operator  unusually 
dexterous,  it  is  better  to  have  the  animal  cast.  The  seton  placed 
on  the  median  line,  under  the  abdomen,  extends  from  about  the 
xyphoid  cartilage  back  to  near  the  sheath  or  other  mammae.  In 
applying  it,  care  must  be  taken  to  avoid  injury  to  the  tunica  abdom- 
inahs  and  the  abdominal  muscles,  or  making  a  deej)  wound  of 
the  abdomen.  Caution  must  also  be  exercised  against  the  possi- 
bility of  the  animal  kicking  against  the  needle  at  the  moment  of 
its  passage  through  the  skin  at  the  opening  of  exit.  The  tape 
when  introduced  in  the  eye  of  the  instrument  is  to  be  drawn  into 
the  tract  by  pulling  the  needle  away  from  behind  forward. 

{h)  Setons  to  the  Neck. — These  are  recommended  against  im- 
mobihty  and  periodic  ophthalmia.  They  are  placed  in  an  oblique 
direction,  one  or  two,  on  one  or  both  sides  of  the  neck.  The  hori- 
zontal direction  sometimes  recommended  is  certainly  quite  un- 
likely to  facilitate  the  free  escape  of  pus.  In  introducing  the 
needle  it  is  better  to  direct  it  from  below  upward,  starting  at 
about  the  level  of  the  convexity  of  the  mastoido-humeralis  muscle. 

{I)  Setons  on  the  Cheeks. — These  have  been  more  or  less  ad- 
vised in  the  treatment  of  diseases  of  the  eyes,  and  principally  of 
periodic  ophthalmia.  They  are  placed  a  little  below  the  zygomat- 
ic spine,  below  and  in  front  of  the  temporo-maxillary  articulation, 
and  extend  downward  some  distance  in  front  of  the  zygomatic 
crest.  The  blood  vessels  of  that  region,  and  jn-incipally  the  large 
nerves  which  cover  the  masseter  muscles,  must  be  carefully  avoid- 
ed, to  guard  against  paralysis  of  the  lip. 

{J)  /Setons  in  the  Foot. — The  insertion  of  a  seton  in  the  foot, 
or  the  frog-seton,  as  it  is  also  called,  has  been  principally  recom- 
mended in  the  treatment  of  navicular  disease,  though  it  is  con- 
sidered by  many  as  of  very  doubtful  utihty.  A  special  curved 
needle  (see  Fig.  222)  is  used  for  the  purpose.  The  horse  is  in 
some  instances  kept  in  the  standing  jDOsition,  while  in  some  special 
cases  it  is  better  to  have  him  thrown. 


EOWEL    SETON.  197 

The  shoe  being  removed,  and  the  sole  and  frog  pared  down 
and  made  as  thin  as  possible,  either  an  incision  may  be  made 
in  the  hollow  of  the  heels,  or  the  needle  inserted  without  it 
through  the  skin,  in  such  a  direction  as  to  have  its  point  emerge 
at  about  the  front  part  of  the  middle  commissure  of  the  frog. 
The  tape  is  drawn  into  position  by  pulling  the  instrument  straight 
away  thi'ough  the  opening  of  exit.  The  seton  is  to  be  secured  by 
tying  ends  together.  When  the  operation  is  performed  while  the 
animal  is  standing,  a  strong  assistant  must  hold  the  foot,  and  the 
needle  pushed  and  passed  through  the  frog  rapidly,  as  by  possible 
struggles,  severe  injuries  of  the  tissues  of  the  posterior  part  of 
the  foot  might  result. 

Rowel  Seton. 

This  form  of  exutory  is  of  earlier  origin  than  the  ordinary  tape 
seton,  and  consists  in  a  round  piece  of  leather,  felt  or  pasteboard, 
sometimes  pei^forated  in  its  center,  which  is  deposited  in  a  pouch 


Fig.  224.— Rowol  Seton. 

made  under  the  skin,  either  simple,  or  sometimes  surrounded 
with  a  band  of  tape  to  prolong  its  continuance.  It  is  principally 
used  when  the  disposition  of  the  parts  renders  the  introduction  of 
a  tape  seton  difficult,  or  when  it  is  for  any  reason  contra  indicated, 
and  especially  when  the  exutory  being  indispensable  to  the  well 
being  of  the  patient,  it  is  at  the  same  time  imperatively  required 
that  the  animal  shall  be  preserved  free  from  any  blemish  or  dis- 
figurement. It  is  also  to  be  preferred  with  animals  which  cannot 
be  prevented  from  tearing  out  the  ordinary  tape  seton  with  their 
teeth. 

A  pau'  of  scissors  and  a  straight  bistomy  are  required  for  its 
insertion.  A  simple  incision  is  made  with  the  bistoury,  long  enough 


198  OPERATIONS    ON    THE    SKIN    AND    CELLULAR    TISSUE. 

to  allow  the  introduction  of  the  rowel,  rolled  or  doubled  on  itself ; 
then,  with  the  scissors  passed  flatwise  under  the  skin,  a  pouch  is 
made,  by  dividing  the  cellular  tissues,  of  sufficient  dimensions  to 
secure  the  rowel,  which  is  to  be  opened  or  unrolled  and  flattened 
in  the  pouch  in  such  a  manner  as  to  bring  its  central  opening  in 
correspondence  with  the  incision  in  the  skin. 

This  form  of  seton  can  remain  for  a  period  of  from  fifteen  to 
twenty  days,  and  there  are  cases  where  it  has  been  kept  in  place 
as  long  as  six  weeks.  It  can  easily  be  removed  with  the  forceps 
or  a  pointed  tenaculum. 

Trochiscus. 

This  is  an  exutory  formed  of  some  mineral  or  vegetable  sub- 
stance, sometimes  termed  an  issue  pea,  possessed  of  irritating  or 
even  caustic  properties,  which  are  introduced  under  the  skin  in  the 
same  manner  as  the  rowel.  They  differ  from  the  other  exutories 
by  causing  a  greater  amount  of  irritation,  a  higher  degree  of  in- 
flammation, and  for  that  reason  are  left  in  place  for  a  shorter 
period,  and  are  removed  as  soon  as  inflammatory  symptoms  are 
well  estabhshed.  They  are  less  frequently  used  in  solij)eds,  but 
are  of  more  common  employment  in  cattle.  In  the  former,  how- 
ever, lameness  of  long  standing  in  the  upper  segments  of  the  legs 
has  been  successfully  relieved  by  them.  In  cattle  they  are  often 
inserted  in  the  dewlap.  They  can  be  introduced  directly  under 
the  skin,  either  through  an  incision  made  alone,  or  attached  to  a 
seton,  which  may  continue  longer  in  place  after  the  removal  of  the 
trochiscus. 

Accidents,  Sequels  of  Setons. 

The  accidents  which  sometimes  follow  the  application  of  setons 
are:  hemorrhage,  gangrenous  swellings,  abscesses,  excessive 
granulations  or  fungosities,  and  indurations. 

(a)  Hemorrhage. — In  ordinary  circumstances,  their  introduc- 
tion is  accompanied  by  the  escape  of  only  a  few  drops  of  blood, 
but  there  are  cases  where  abundant  hemorrhages  occur,  either 
resulting  from  an  injury  to  some  blood  vessels,  or  because  of  a 
special  hemorrhagic  predisposition  ia  the  animal,  as  when  it  is  in 
a  debilitated  or  anaemic  state. 

When  there  is  hemorrhage,  it  usually  shows  itself  at  the  con- 
clusion of  the  operation,  the  blood  oozing  in  drops  from  the  open- 


ACCIDENTS,    SEQUELS    OF    SETONS.  199 

ings  of  the  seton,  or  causing  a  swelling,  if  it  accumulates  in  the 
tract.  The  ordinary  means  of  hemostasis  must  be  employed,  as 
cold  douches,  iced  lotions,  etc.,  and  if  these  fail,  the  seton  must 
be  removed,  and  the  openings  plugged  with  oakum,  moistened 
^vith  hemostatic  liquids,  or  with  absorbent  cotton  ;  or  it  may  even 
be  necessary  to  close  the  openings  with  sutures,  or  resort  to  the 
the  application  of  pressure.  Bouley  recommended  the  introduc- 
tion of  a  thick  tent  of  oakum  through  the  entire  length  of  the 
tract. 

(b)  Gangrenous  Simllings. — These  are  among  the  most  common 
and  dangerous  of  accidents  accompanying  setons,  and  occur  prin- 
cipally during  warm  weather,  in  debilitated  animals,  or  such  as 
are  exposed  to  bad  hygienic  conditions  or  affected  with  some 
special  diseases. 

The  gangrene  manifests  itself  by  the  appearance  of  a  warm 
and  painful  swelling,  oedematous  and  diffused,  spreading  rapidly, 
but  in  the  central  portion  cold  and  painless,  and  a  general  reaction 
soon  becomes  manifest.  The  animal  becomes  dvdl ;  the  j)ulse  is 
accelerated  and  small,  and  the  temperature  heightened,  the  dis- 
charge of  the  setons  has  changed  its  character  to  that  of  a  thin, 
sanious,  and  very  foetid  suppuration.  All  these  symptoms  become 
rapidly  exaggerated,  and  soon  threaten  the  life  of  the  patient, 
unless  heroic  measures  are  at  once  resorted  to. 

When  the  tract  assumes  this  gangrenous  aspect  the  tape  must 
be  immediately  removed,  and  the  tract  thoroughly  emptied  and 
cleansed,  by  injections  of  antiseptic  liquids  such  as  solutions  of 
phenic  or  saHcylic  acid,  followed  by  cauterization  with  the  red 
iron  in.  the  tract,  and  through  the  oedematous  swelling,  accom- 
panied by  the  free  administration  of  tonics  and  antiseptics  inter- 
nally. No  means  should  be  neglected  likely  to  overcome  the 
threatening  septicemia,  which,  if  not  controlled,  will  certainly  have 
a  fatal  termination. 

(c)  Abscesses. — When  the  seton  has  been  left  in  place  too  long, 
or  there  has  been  neglect  in  respect  to  the  care  and  cleanliness  of 
the  tract,  or  when  the  tape  has  been  removed,  numerous  abscesses 
will  sometimes  be  found  along  the  course  of  the  seton.  They 
have  the  character  of  phlegmonous  swellings,  and  soon  become 
fluctuating, 

AVhile  they  remain  superficial,  no  sei'ious  results  need  be  appre- 
hended, and  all  they  re(j[ULre  is  to  be  opened  to  allow  the  escaj^e 


200  OPERATIONS    ON    THE    SKIN    AND    CELLULAE    TISSUE. 

of  the  pus,  and  to  be  treated  generally  after  the  manner  of  similar 
tumors  in  other  parts  of  the  body.  But  occasionally  a  filtration 
of  the  pus  takes  place  between  the  different  layers  of  tissues,  and 
the  abscesses  become  troublesome.  To  avoid  their  formation 
there  must  be  a  complete  and  regular  evacuation  of  the  tract  by 
pressing  out  the  contents  once  a  day  or  oftener,  according  as 
the  discharge  requires  it.  To  avoid  the  possibility  of  the  migra- 
tion of  the  pus  and  the  formation  of  a  deep  abscess,  the  operator 
must  be  careful  not  to  make  a  false  tract  with  the  needle  during 
its  passage  under  the  skin. 

(d)  Excessive  Granulations  or  Fungosities. — These  often  occur 
at  the  openings  of  the  tract,  when  the  tape  has  been  left  in  place 
a  long  time.  They  are  not  of  a  serious  character,  and  can  be  re- 
moved by  excision  or  cauterization. 

(e)  Indurations. — These  are  also  among  the  sequelae  of  setons 
left  in  position  too  long,  or  when,  after  the  removal  of  the  tape, 
care  has  not  been  taken  to  press  out  and  thoroughly  empty  the 
tract  of  any  remaining  portion  of  the  discharge.  These  indurations 
appear  in  the  form  of  long,  hardened  cords,  extending  moi'e  or 
less  in  the  original  length  of  the  setons.  They  often  disappear 
spontaneously,  by  a  slow  process  of  resorption,  but  in  many  cases 
it  becomes  necessary  to  have  recourse  to  friction  with  alterative 
ointments  composed  of  preparations  of  mercury  or  iodine.  Deep 
pointed  cauterization,  or  their  entire  removal  by  dissection  are  also 
recommended. 

ABLATION  OF  TUMOES. 

Under  this  heading  are  included  the  various  modes  of  the  divi- 
sion of  tissues  involved  in  the  removal  of  tumors — a  tumor  being, 
as  technically  defined,  a  non-inflammatory  mass,  constituted  by 
tissues  of  new  formation,  and  having  a  tendency  to  i^ersistency 
and  possible  growth. 

The  term  ablation,  of  which  the  common  definition  is  simj)ly 
taking  avmy,  is  in  surgery  employed  to  denote  the  excision  or  re- 
moval of  tumors — a  tumor  being,  in  a  surgical  sense,  any  morbid, 
circumscribed  enlargement  affecting  any  of  the  structures  or  organs 
of  the  body,  sometimes  harmless,  and  sometimes  malignant  and 
fatal  in  their  character  and  termination. 

The  siu-gical  means  at  the  disposal  of  the  veterinarian,  by 
which  this  operation  is  accomplished,  are  not  so  numerous  as 


ABLATION    OF    TUMORS.  201 

those  employed  in  liumau  surgery,  and  can  be  comprehended  in 
the  four  principal  processes  of  excision,  ligature,  tearing  and 
puncture.  They  are  about  equally  employed,  according  to  the 
cu-cumstances  and  nature  of  the  case,  and  the  discretion  of  the 
opei-ator. 

1st. — Excision. 

This  mode  of  ablation  can  be  performed  in  four  ways,  with 
the  scissors,  the  bistoury,  the  ecraseur  or  the  thermo-cautery. 

(a)  With  the  Scissors. — This  is  the  simplest  process,  but  is 
apphcable  only  to  tumors  of  diminutive  size,  such  as  warts,  con- 
dyloma, and  in  general,  to  growths  having  a  small  and  narrow 
peduncle.  Curved  scissors  are  generally  used.  The  tumor  is 
raised  from  the  skin  and  secured  with  a  pair  of  bull-dog  forceps 
before  the  scissors  are  applied.  The  hemorrhage  which  may 
follow  is  not  usually  serious,  and  ordinarily  requires  no  interfer- 
ence, and  when  necessary,  can  be  readily  controlled  by  means  of 
cooling  aj)pUcations,  pressure  or  cauterization. 

(/>)  With  the  Bistoury. — A\Tien  the  tumor  is  comparatively 
small,  with  a  narrow  peduncle,  its  removal  is  effected  in  the  same 
manner  as  with  the  scissors,  the  only  change  being  in  the  stroke 
of  the  instrument.  Usually  a  single  stroke  of  the  bistoury  is  suf- 
ficient. But  if  the  tumor  is  of  large  dimensions  and  covered  by 
the  skin,  the  operation  becomes  more  complicated  and  requires 
more  time  and  care.  It  is  ordinarily  divided  into  three  steps,  viz. : 
the  incision  of  the  skin,  the  dissection  of  the  tumor,  and  its  extir- 
pation. 

The  form  and  size  of  the  incision  must  of  course  correspond 
to  those  of  the  tumor,  which  must  be  considered  in  reference 
to  its  basis,  connections,  adhesions  and  surrounding  tissues,  as 
well  as  the  healthy  or  morbid  condition  of  the  teguments.  The 
straight  incision  is  ajiplicable  to  subcutaneous  tumors,  free  from 
adhesions  or  comparatively  loose  and  susceptible  of  enucleation, 
while  that  made  through  a  fold  of  the  skin  is  better  adapted  to 
encysted  growths,  which  it  would  be  dangerous  to  open.  The 
elliptic  incision  is  used  when  aj)ortionof  the  skin  is  to  be  removed, 
because  of  its  being  diseased  or  too  thin,  and  its  closing  up  would 
be  too  difficult;  or  when  the  extent  of  the  skin  exceeds  that  of 
the  wound  it  covers.  Crucial  incisions,  or  those  of  the  T  or  Y 
shape,  are  indicated  when  a  tumor  of  large  size  is  to  be  exposed, 


202  OPERATIONS    ON    THE    SKIN    AND    CELLULAR    TISSUE. 

while  it  is  necessary  to  preserve  the  skin  which  covers  it.  "^Tiat- 
ever  form  of  incision  may  be  used,  it  must  always  extend  beyond 
the  base  of  the  tumor  to  allow  a  free  dissection  and  an  easy  removal 
of  all  the  diseased  tissues.  The  convex  bistoury  is  preferred  in 
this  step  of  an  operation  and  must  be  applied  with  light  pressure, 
and  a  very  guarded  motion,  to  avoid  any  subcutaneous  blood  ves- 
sels that  may  run  over  the  surface  of  the  growth,  and  which  may 
be  of  large  size. 

The  incision  is  followed  by  the  dissection,  which  is  done  with 
the  scalpel  or  the  bistoury,  by  separating  the  tumor  from  the  teg- 
uments, carefully  avoiding  surrounding  structures,  which  should 
be  held  aside  with  the  forceps  or  tenaculum,  in  order  to  keep 
the  wound  open  and  accessible.  Instead  of  the  scaljiel  or  bis- 
toury, the  blunt  end  of  the  scissors  sometimes  becomes  the  in- 
strument by  which  the  adhesions  of  the  cellular  tissue  covering 
the  tumor  are  most  easily  destroyed. 

In  the  third  step,  or  the  extirpation  of  the  tumor,  either  the 
bistoury,  the  scalpel  or  the  sage  knife  may  be  the  most  eUgible  in- 
strument, according  to  the  consistency  of  the  tumor,  whether  hard, 
cartilaginous  or  bony  If  it  is  of  sufficiently  small  size,  by  steady- 
ing it  with  the  forceps  or  tenaculum,  it  may  be  excised  with  a 
single  stroke  of  the  instrument.  If  too  large  for  this,  it  may  be 
controlled  by  passing  a  loop  of  ribbon  or  tape  through  it,  by  which 
its  position  can  be  changed  at  pleasure,  to  facilitate  its  com^Dlete 
dissection.  The  hemorrhage  following  may  be  arrested  by  any  of 
the  usual  hemostatic  measures.  When  the  tumor  is  of  large  di- 
mensions this  last  step  of  the  operation  will  require  great  care  in 
the  execution,  and  the  blood  vessels  which  may  run  through  its 
base  must  be  securely  Hgated  before  the  tumor  is  entirely  excised. 


Fig.  226.— Ecraseur  of  Chassaignac. 


ABLATION    OF    TUMORS. 


203 


(c)  With  the  Ecrai^eiir. — The  instrument  used  iu  this  method 
has  received  its  name  from  the  fact  of  its  crushing  action  ujoon  the 
tissues  upon  which  it  is  apphed  and  for  which  it  was  invented  by 
Chassaignac.  The  original  form  of  the  instrument  of  Chassaig- 
nac  has  been  subjected  to  various  modifications,  some  being  made 
to  use  with  a  chain  alone,  others  to  carry  a  wire,  and  others 
again  to  carry  a  chain  or  a  wire  alternately.  Others  like  that  of 
Beynal,  of  IVIiles,  of  Smith,  and  many  others,  vary  also  in  shape  or  in 
size,  but  without  differing  in  their  general  principles,  and  whether 
employed  for  the  removal  of  tumors,  or  in  special  operations,  as 


Fig.  227.— Ecraseur  with  Wire. 


Fig.  228.— Ecraseur  with  Chain  or  Wire. 


those  ot  castrations  in  males,  or  spaying  in  females,  the  modus 
operandi  remains  the  same.  This  consists  in  enclosing  the  base 
or  peduncle  of  the  tumor  with  the  chain  or  wire  of  the  instru- 
ment, and  tightening  it  more  or  less  rapidly  at  the  discretion  of 
the  operator,  by  means  of  the  screw  in  the  handle  until  it  is  com- 
pressed, strangulated  and  crushed,  and  at  last  entirely  separated. 
The  action  should  be  more  or  less  gradual,  according  to  the  size 
of  the  parts  and  the  consistency  and  vascularity  of  the  tissues.     A 


204 


OPERATIONS    ON    THE    SKIN    AND    CELLULAR    TISSUE. 


Fig.  229a.— Haussman  Ecraseur. 


slow  movement  of  the  ecraseur  is  essential  to  avoid  hemorrhage, 
but  although  this  rule  is  recommended  by  Eiu-opean  authors,  it 
does  not  seem  to  be  as  important  as  it  is  reported  to  be,  if  we 
may  judge  by  the  results  obtained  by  American  practitioners,  in 
view  of  the  manner  in  which  they  use  this  instrument  in  the 
operations  of  castration.  Our  experience,  however,  justifies  a 
slow  and  careful  application  of  the  crushing  process,  especially  in 
the  removal  of  tumors  where  blood  vessels  of  large  size  or  in  a 
state  of  disease  may  be  known  to  ramify,  and  particularly  in  the 
ablations  of  the  champignon  of  castration. 


ABLATION    OF    TUMORS.  205 

{(I)  With  the  Thermo- Cautery. — The  ablation  of  tumors  can 
also  be  performed  with  the  flat  i^latinum  cautery  of  Paquelin, 
well  heated,  by  following  the  same  rules  as  with  the  bistoury, 
both  when  either  the  growths  are  small,  or  the  incision  of  the  skin 
and  dissections  of  the  tumor  have  been  previously  performed. 
The  advantages  gained  by  the  use  of  the  red-heated  cautery  in 
controlling  the  hemorrhage  while  the  incision  goes  on,  is  too  ob- 
vious and  important  to  be  ignored  or  depreciated. 

2d. — Ligature. 

The  ligatiu'e  operates  on  the  tumor  in  its  o^vn  peculiar  and 
effective  way,  by  circumscribing  the  base  and  deiDriving  it  of  its 
nutriment  by  occluding  the  circulation  and  leaving  it  to  undergo 
the  process  of  gangrenous  dissolution  and  sloughing,  with  the  ad- 
vantage of  obviating  any  apprehended  danger  of  subsequent  hem- 
orrhage. The  kind  of  ligatures  used  for  this  purpose  will  vary 
with  the  choice  of  the  practitioner.  In  veterinary  surgery,  the 
material  is  variously  flax,  hemp,  silk,  catgut,  india  rubber  cords,  or 
metaUic  wire.  Whipcord  or  fishing  line  is  often  used,  when  a 
powerfvd  constriction  is  to  be  apj)lied,  and  their  efficiency  is  in- 
creased by  being  waxed  or  soaped.  There  are  various  ways  of 
aj)plying  a  ligature,  but  they  are  all  subject  to  the  following  rules: 
the  size  of  the  ligature  must  be  proportioned  to  that  of  the  parts 
to  be  Hgated,  and  to  their  resistance ;  it  ought  to  be  ajiplied  only 
upon  a  Hniited  portion  of  the  tissues,  and  the  skin  ought  never  to 
be  included,  except  when  the  peduncle  is  very  narrow,  or  the  skin 
already  ulcerated. 

Mrst  Method,  Simple  Ligature. — A  cord  or  band  is  affixed 
around  the  base  of  the  tumor,  and  tightly  tied  by  a  single  knot. 
Sometimes  the  bleeding  knot  or  double  clove-hitch  is  preferred, 
drawn  tightly  and  secured  by  a  simple  knot. 

The  mortification  of  the  growth  may  be  accelerated,  if  thought 
proper,  by  covering  the  ligature  with  some  caustic  jDreparation, 
such  as  an  ointment  of  sulphide  of  arsenic,  or  also  by  adding  to 
the  effect  of  the  hgature  that  of  the  actual  cautery. 

Second  Method,  Double  Ligature.  —  This  is 
brought  into  requisition  when  the  peduncle  of  the 
tumor  is  too  large  to  be  easily  embraced  by  a  sin- 
gle ligature.    It  is  made  by  i)iercing  the  l^ase  of  the   j,j^_  ssa-Tapeetry 
growth  thi-ough  the  centre,  by  means  of  a  straight  Ligature. 


206  OPERATIONS    ON    THE    SKIN    AND    CELLULAE    TISSUE. 

needle  with  a  double  thread  or  cord,  thus  dividing  the  growth 
into  separate  halves,  each  having  its  own  distinct  ligatiu'e,  tied 
on  opposite  sides  of  the  peduncle. 

Third  Method,  Midtiple  Ligature. — At  times,  the  tumor  may 
have  a  sufficiently  wide  base  to  require  the  addition  of  a  third 
ligature  in  order  to  secure  a  sufficient  amount  of  constriction  to 
slough  the  entire  mass,  in  which  case  special  needles  become 
necessary.  These  are  longer  than  the  ordinary  ones,  though 
more  or  less  flexible,  and  with  an  eye  in  the  centre,  additional  to 
that  at  the  extremity,  according  to  indications. 

When  the  tumor  is  to  be  divided  into  three  j)ortions  two 
needles  are  necessary,  and  a  correspondingly  long  thread.  The 
needles  being  passed  together  through  the  base  of  the  tumor,  with 
sufficient  intervals  between  to  divide  it  into  three  nearly  equal 


Fig.  231.— Treble  Ligature. 

parts,  leave,  when  drawn  through,  three  hgatures  with  which  to 
enclose  separately  the  central  and  two  lateral  portions  of  the 
l^eduncle. 

If  it  becomes  necessary  to  aj)ply  four  ligatures,  two  different 
needles  are  necessary,  one  (female)  long,  having  an  eye  in  the 


Fig.  232.— Female  Needle.  Fig.  233.— Male  Needle. 

centre,  and  another  (male)  of  the  ordinary  form,  with  the  eye  at 
its  extremity,  but  of  a  size  which  will  permit  its  passage  with  a 
double  thread  through  the  central  eye  of  the  other.  This  male 
needle  is  to  carry  a  long,  double  thread.  The  manipulation  is 
very  obvious.  The  first  needle  is  inserted  far  enough  to  bring 
the  central  eye  half  way  through  the  growth,  and  the  second 
needle  is  passed  through  it,  and  out  at  the  other  side;  then,  di-aw- 
ing  out  the  first,  two  double  ligatures  are  left,  or  one  for  each 
quarter  of  the  tumor.  All  that  then  remains  is  the  tying  of  the 
four  knots. 

To  describe  it  more  in  detail,  the  female  needle  is  inserted  in 


ABLATION    OF    TUMORS. 


207 


-let  Step  of  the  Ligature 
by  Four. 


Step  of  the  Ligature 
by  Foui-. 


the  growtli  vintil  the  eye  reaches  the  centre,  when  the  male  needle 
is  introduced  at  a  right  angle  with  it,  and  j^assed  through  the  eye, 
as  in  Fig.  234,  to  be  drawn  out  on  the  opposite  side  of  the  tumor 
carrying  the  ligatures  with  it  (Fig.  235). 

In  the  second  step  of  the  operation,  the  passage  of  the  male 
needle  through  the  tumor  with  the  double  ligature  is  completed, 
and  by  the  sej)aration  of  the  needle  from  one  of  the  threads,  two 
threads  are  left  loose.  The  female  needle  is  then  pushed  through 
the  tumor,  when  one  of  the  threads  is  cut  off  (Fig.  236) ;  the  fourth 
step  being  completed  by  having  the  female  needle  drawn  back 


Fia.  236.— 3d  Step  of  the  Ligature 
by  Four. 


Fig.  237.— 4th  Step  of  the  Ligature 
by  Four. 


through  its  original  tract  with  the  last  threads  or  loop  (Fig.  237), 
and  when  the  needle  is  finally  sej^arated,  it  leaves  the  tumor  divided 
into  four  segments  by  four  threads,  whose  extremities  are  drawn 
and  tightly  secured  by  a  single  knot  (Figs.  238,  239). 


208 


OPEKATIONS    ON    THE    SKIN    AND    CELLULAR    TISSUE. 


Fig.  239.— The  Liga- 
tures Secured. 


Fig.  238.— The  Tumor  divided 
In  Four. 

Fourth  Method,  Subcutaneous  Ligature. — This  method  is  sel- 
dom practiced,  as  there  are  always  objections  to  leaving  under 
the  skin  the  mortified  structures  divided  by  the  constriction  of  the 
cord.  But  as  there  may  be  circumstances  under  which  the  growth 
cannot  be  immediately  uncovered,  its  application  becomes  a  ques- 
tion of  necessity. 

Three  needles  are  required:  one,  A,  straight  and  sharp;  the 
second,  B,  straight  and  pointed;  the  third,  C,  curved  and  also 
pointed.      These  are  placed  upon  a  single  long  thread. 


Fig.  240.— Thread  and  Needles  for  Subcutaneous  Ligatiires.         FiG.  241.— 1st  Step. 

The  growth  A  being  subcutaneous,  and  spherical  in  shape,  a 
vertical  cutaneous  fold  is  raised  above  its  superior  thii'd,  through 
the  base  of  which  the  needle  A  is  introduced.  Leaving  the  fold 
loose,  and  the  skin  resuming  its  position,  a  first  portion  of  Uga- 
ture  is  found  in  place,  under  the  teguments,  surrounding  one- 
third  of  the  cii-cumference  at  C  (Fig.  2il).  The  curved  needle,  C, 
is  then  passed  through  the  tumor,  entering  at  C,  and  coming  out 
at  B,  with  the  loop  D,  and  at  B  the  needle  is  removed  (Fig.  242). 

By  these  first  steps  of  the  operation,  the  superior  thii'd  of  the 
growth  is  surrounded  by  the  loop  of  thread  B,  C,  D,  both  of  whose 


ABLATION    OF    TUMOKS. 


209 


Fig.  242.— 2d  Step.  Fig.  243.-3(1  Step. 

extremities  come  out  by  the  same  opening  (Fig.  243),  while  a  sec- 
ond thread,  f  f,  is  free  between  the  superior  and  the  two  lower 
thii'ds  of  the  tumor  (Fig.  244). 

The  manipulations  for  the  superior  third  of  the  growth  are 
repeated  for  the  lower  third,  with  another  thread,  and  the  middle 
third  is  then  surrounded  by  two  parallel  threads  A,  B  and  C,  D 
(Fig.  245). 


Fig.  244.— 4th  Step.  Fig.  245.— 5th  Step. 

Both  of  these  two  threads  are  passed  into  the  curved  needle, 
and  it  then  becomes  easy  to  carry  under  the  skin  the  extremity  of 
the  thread  B  to  the  opening  D,  and  the  thread  A  to  the  opening 
C,  where  it  will  be  tied  to  thread  B.  AU  the  threads  A,  B,  C,  D 
will  thus  form  a  loop  embracing  the  middle  third  of  the  growth, 
as  the  other  threads  wiU  surround  the  upper  and  the  lower  thirds. 
All  the  ligatures  can  be  then  tied  to  the  required  degree  and  the 
operation  is  completed  (Figs.  246,  247). 


Fig.  216.— The  Ligatures  in 
Position. 


Fig.  247.— The  Ligature 
Secured. 


When  the  ligature  that  is  to  apply  the  necessary  constriction 
upon  the  base  of  the  tumor  is  in  place,  it  must  be  tied  more  or 


210  OPERATIONS    ON    THE    SKIN    AND    CELLULAR    TISSUE. 

less  suddenly  and  firmly,  but  never  with  sufficient  force  to  pro- 
duce an  immediate  section,  an  operation  which  could  have  been 
more  easily  performed,  and  with  less  pain,  with  the  bistoury.  To 
avoid  this  section,  apply  the  constriction  slowly,  and  in  accordance 
with  the  effects  produced,  and  the  resistance  encountered  by  the 
ligature.  If  the  tissues  are  soft  and  frangible,  it  would  be  unsafe 
to  comjolete  the  constriction  at  once,  and  it  should  be  deferred 
to  a  later  period ;  if,  on  the  contrary,  it  is  hard  and  resisting,  the 
ligature  may  be  drawn  tightly,  and  firmly  tied  at  once.  Ordinary 
traction  on  the  ligature  may  be  made  with  the  hands  only,  but 
when  extra  strong  and  steady  traction  is  required,  wooden  holders 
will  prove  of  great  assistance.  These  means  of  securing  the  Hga- 
ture  on  the  tumor  are  successful  so  long  as  it  is  comparatively 
superficial,  but  if  it  is  situated  at  a  certain  depth,  special  instru- 
ments are  required.  Among  these  is  one  particularly  adapted  to 
the  removal  of  growths  from  the  natural  cavities,  such  as  the 
nasal,  rectal,  vaginal  or  inguinal  regions.  It  consists  of  a  wooden 
or  metallic  tube,  of  variable  length,  through  which  the  loop  of  a 
double,  strong,  waxed  hgature  can  be  introduced  into  the  cavity 


Fig.  248.— Ligature  Carrier. 

and  adjusted  around  the  base  of  the  tumor,  and  when  in  position, 
tightened  by  traction  on  the  thread  at  the  mouth  of  the  tube,  and 
so  secured  that  the  constriction  can  be  maintained  at  any  degree 
of  tightness,  and  increased  or  relaxed  at  pleasure. 

3d. — Elastic  Ligature. 

This  is  but  a  variation  from  the  ordinary  ligature,  in  which 
an  india-rubber  cord  or  tubing  of  suitable  diameter  is  substi- 
tuted for  the  other  means  of  constriction.  It  is  applied  like  the 
others  at  the  base  of  the  tumor,  and  secured  in  the  same  manner. 
The  peculiarity  of  its  action  arises,  of  course,  from  its  elasticity, 
the  result  of  which  is  a  constant  unrelaxing,  self-regulating  con- 
striction, which  continues  automatically  until  the  ablation  is 
eifected. 

The  growth  upon  which  the  elastic  Hgature  is  apj)Hed  soon 
begins  to  undergo  changes,  which  may  be  at  first  unnoticeable. 


ABLATION    OF    TUMORS.  211 

But  presently  it  becomes  cooler,  the  skin  becomes  soft,  flabby, 
and  of  a  dark  brownish  color ;  the  mass  becomes  dry  and  con- 
tracted, and  in  from  fifteen  to  twenty  days  it  drops  off,  leaving  a 
wound  which  heals  in  the  usual  manner. 

The  use  of  this  Hgature  is,  we  believe,  principally  advantage- 
ous for  small  growths,  and  we  have  obtained  good  results  from  it 
in  the  castration  of  medium  or  small-sized  animals,  as  weU  as  in  the 
treatment  of  small  and  superficial  tumors,  as  warts,  and  the  like. 
But  in  respect  to  large  growths,  such  as  the  fibromas  of  the  elbow 
joint,  from  the  enormous  size  of  the  wovmd  which  follows,  and 
the  excessive  length  of  time  this  requires  to  heal,  we  cannot  feel 
justified  in  recommendiag  it  ia  similar  cases. 

4th. — Removal  by  Tearing. 

This  is  a  method  of  extirpating  tumors  by  mere  force,  grasp- 
ing them  with  one  hand  or  with  the  forceps,  and  with  the  other 
they  are  simply — with  a  twisting  motion — torn  from  their  connec- 
tion. Of  course  it  can  only  be  practiced  on  small  growths,  but  it 
has  the  advantage  of  preventing  hemorrhage,  and  can  be  performed 
with  the  hands  alone,  or  Avith  the  assistance  of  special  forcej^s  or 
nippers.  The  princii^al  objection  is  that  it  sometimes  fails  to 
remove  the  fundamental  element  of  the  growth,  and  a  renewal 
of  the  trouble  may  be  looked  for. 

5th. — Puncture. 
This  subject  has  already  been  partially  considered.  It  is  per- 
formed with  either  the  bistoury,  the  lancet,  or  the  trocai",  but  it 
is  princiiDally  appHcable  to  soft  tumors  only,  and  as  by  its  un- 
aided action  it  is  ordinarily  insufficient  to  effect  their  complete 
disappearance,  it  becomes  necessary  to  resort  to  instrumental  help, 
in  which  cauterization  with  the  pointed  red  iron,  blistering  applica- 
tions, or  the  injection  of  irritating  or  modifying  compounds,  as 
solution  of  tincture  of  iodine,  become  the  efficient  adjuncts,  if  not 
in  truth  the  actual  cm-atives. 


CHAPTEE  VI. 


OPERATIONS  ON  BONES. 


FEACTURES. 

In  technical  language  a  fracture  is  a  '•  solution  of  continuity  in 
the  structure  or  substance  of  a  bone,"  and  it  ranks  among  the 
most  serious  of  the  lesions  to  which  the  horse — or  any  animal — 
can  be  subject.  It  is  a  subject  of  special  interest  to  veterinarians, 
and  to  horse  owners  as  well,  in  view  of  the  variety  of  forms  in 
which  it  may  occur,  as  well  as  of  the  loss  of  time  to  which  it  sub- 
jects the  patient,  and  the  consequent  suspension  of  his  earning 
capacity.  Though  of  less  serious  consequence  in  the  horse  than 
in  man,  it  is  always  a  matter  of  grave  import.  It 
is  always  slow  and  tedious  in  healing,  and  is  fre- 
quently of  doubtful  and  unsatisfactory  result. 

This  solution  of  continuity  may  take  place  in 
two  principal  ways.  In  the  most  numerous  in- 
stances it  includes  the  total  thickness  of  the  bone 
and  is  a  compUte  fractiu-e.  In  other  cases  it  in 
volves  a  portion  only  of  the  thickness  of  the  bone, 
and  for  that  reason  is  described  as 
incom2')lete  (Fig.  250).  If  the  bone 
is  divided  into  two  separate  portions, 
and  the  soft  parts  have  received  no 
injury,  the  fracture  is  a  simj^le  one ; 
or  it  becomes  comjyound  if  the  soft 
parts  have  suffered  laceration,  and 
comminuted  if  the  bones  have  been 
crushed  or  ground  into  fragments, 
many  or  few.  The  direction  of  the 
break  also  determines  its  further 
classification.  Broken  at  a  right  an- 
p-le,  it  is  transverse  (Fig.  251) ;  at  a 

Fig.  249.— Complete      °'  ° 

Fracture  different  angle  it  becomes  oblique 


FRACTURES.  . 


213 


(Fig.  252),  and  it  may  be  longitudinal  or  lengthwise.  In  a  com- 
plete fracture,  especially  of  the  obHque  kind,  there  is  a  condition 
of  great  importance  in  respect  to  its  effect  upon  the  ultimate  re- 
sult of  the  treatment,  in  the  fact  that  from  various  causes,  such  as 
muscular  contractions  or  excessive  motion,  the  bony  fragments  do 
not  maintain  their  mutual  coaptation,  but  become  separated  at  the 
ends,  and  this  fact  has  made  it  necessary  to  add  another  descrip- 
tive term  in  the  words — loith  displacement.  And  this  term  again 
suggests  its  negative,  and  introduces  the  fracture  loithout  displace- 


FiG.  251.— Transverse 
Fracture  of  the  Radius. 


Fig.  252.— Oblique  Frac- 
ture of  the  Femur. 


214  OPERATIONS    ON    BONES. 

me7it,  when  the  facts  justify  this  description.  Again,  a  fracture 
may  be  intror-articular  or  extra^artlcular,  as  it  extends  within  a 
joint  or  otherwise,  and  once  more,  intra-periosteal,  when  the  j)eri- 
osteum  remains  intact.  And,  finally,  there  is  no  absolute  Hmit  to 
the  use  of  descriptive  terminology  in  the  case. 

The  condition  of  displacement  is  largely  influential  in  deter- 
mining the  question  of  treatment,  and  as  affecting  the  final  result 
of  a  case  of  fracture.  This,  however,  is  dependent  npon  its  loca- 
tion or  whether  its  seat  be  in  one  or  more  of  the  axes  of  the  bone, 
in  its  length,  its  breadth,  its  thicknsss,  or  its  circumference.  An 
incomplete  fracture  may  also  be  either  simple  or  comminuted,  the 
periosteum,  in  the  latter  case  when  it  is  intact,  keeping  the  frag- 
ments together,  the  fracture  in  that  case  belonging  to  the  intra- 
periosteal  class.  At  times  there  is  only  a  simj^le  fissure  or  spht 
in  the  bone,  making  a  condition  of  much  difficulty  of  diagnosis. 

Two  varieties  of  originating  cause  may  be  recognized  in  cases 
of  fracture.  They  are  the  predisposing  and  the  occasional.  As 
to  the  first,  different  species  of  animals  differ  in  the  degree  of  their 
liability.  That  of  the  dog  is  greater  than  that  of  the  horse,  and,  in 
horses,  the  various  questions  of  age,  the  mode  of  labor,  the  season 
of  the  year,  the  portion  of  the  body  most  exposed,  and  the  existence 
of  ailments,  local  and  general,  are  all  to  be  taken  into  account. 

Among  horses,  those  employed  in  heavy  draught  work  or  that 
are  driven  over  bad  roads,  are  more  exposed  than  light-draught 
or  saddle  horses,  and  animals  of  different  ages  are  not  equally 
liable.  Dogs  and  young  horses,  with  those  which  have  become 
sufficiently  aged  for  their  bones  to  have  acquired  an  enhanced 
degree  of  frangibility,  are  more  Hable  than  those  which  have  not 
exceeded  the  time  of  their  adult  prime.  The  season  of  the  year 
is  undoubtedly,  though  in  an  incidental  way,  an  imj^ortant  factor 
in  the  problem  of  the  etiology  of  these  accidents,  for  though  they 
may  be  observed  at  all  times,  it  is  during  the  months  when  the 
shppery  condition  of  the  icy  roads  renders  it  difficult  for  both 
men  and  beasts  to  keep  their  feet,  that  they  occur  most  frequently. 
The  long  bones,  those  especially  which  belong  to  the  extremities, 
are  most  frequently  the  seat  of  fractures,  from  the  circumstance  of 
their  superficial  position ;  their  exposure  to  contact  and  collision, 
and  the  violent  muscvdar  efforts  involved  both  in  their  constant 
rapid  movement  and  their  labor  in  the  shafts  or  at  the  pole  of 
heavy  and  heavily  laden  carriages. 


FEACTUEES.  215 

The  relation  between  sundry  idiosyncrasies  and  diatheses  and 
a  hability  to  fractvires  is  too  constant  and  well  established  a  path- 
ological fact  to  need  more  than  a  passing  reference.  The  history 
of  rachitis,  of  melanosis,  and  of  osteo-porosis,  as  related  to  an 
abnormal  frangibility  of  the  bones,  is  a  part  of  our  common  medi- 
cal knowledge.  There  are  few  persons  who  have  not  known  of 
cases  among  their  friends  of  frequent  and  almost  spontaneous 
fractures,  or  at  least  of  such  as  seem  to  be  produced  by  the 
sHghtest  and  most  inadequate  violence,  and  there  is  no  tangible 
reason  for  doubting  an  analogous  condition  in  individuals  of  the 
equine  constitution.  Among  local  predisposing  affections,  mention 
must  not  be  omitted  of  such  bony  diseases  as  caries,  tuberculosis, 
and  others  of  the  same  class. 

Occasional  or  "efficient"  causes  of  fracture  are  in  most 
instances  external  traumatisms,  as  violent  contacts,  collisions, 
falls,  etc.,  or  sudden  muscular  contractions.  These  external  acci- 
dents are  various  in  their  character,  and  are  usually  associated 
with  quick  muscular  exertion.  A  violent,  ineffectual  effort  to 
move  too  heavy  a  load ;  semi-spasmodic  bracing  of  the  frame  to 
avoid  a  fall  or  resist  a  pressure;  a  quick  jump  to  escape  a  blow; 
stopping  too  suddenly  after  speeding;  struggling  to  liberate  a 
foot  from  a  rail — perhaps  to  be  thrown  in  the  effort — all  these  are 
familiar  and  easy  examples  of  accidents  happening  hourly,  by 
which  our  equine  servants  become  sufferers.  "We  may  add  to 
these  the  fracture  of  the  bones  of  the  vertebrae,  occurring  when 
a  patient  is  cast  for  the  purpose  of  undergoing  a  surgical  opera- 
tion, cpiite  as  much  the  result  of  muscular  contraction  as  of  a  j^re- 
existing  diseased  condition  of  the  bones.  A  fracture  occurring 
under  these  circumstances  may  be  called  with  jDropriety  hidirect, 
while  one  which  has  resixlted  from  a  blow  or  a  fall  differently 
caused  is  of  the  direct  kind. 

The  symptoms  belonging  to  the  existence  of  fracture  vary  ac- 
cording to  the  site  of  the  lesion.  In  case  of  its  being  on  a  bone 
of  the  extremity  there  is  irregularity  in  the  performance  of  the 
functions  of  the  apparatus  to  which  the  fractured  bone  belongs, 
and  as  a  necessary  consequence  of  the  existing  lesion,  lameness 
more  or  less  marked.  If  the  broken  bone  belongs  to  one  of  the 
extremities,  the  impossibility  of  the  performance  of  its  natural 
function,  in  sustaining  the  weight  of  the  body  and  contributing  to 
the  act  of  locomotion,  is  usually  complete,  though  the  deo-ree  of 


216  OPERATIONS    ON    BONES. 

powerlessness  -svill  vary  according  to  tlie  kind  of  fractui-e  and  tlie 
bone  wliicli  is  injured.  For  example,  a  fracture  of  the  cannon 
bone  without  displacement,  or  of  one  of  the  phalanges  which  are 
siH"rounded  and  sustained  by  a  complex  fibrous  structru'e,  is,  in  a 
certain  degree,  not  incompatible  with  some  amount  of  resting  of 
the  foot.  But,  on  the  contrary,  if  the  shank  bone,  or  that  of  the 
forearm  be  the  impHcated  member,  it  would  be  vei-y  difficult  for 
the  leg  to  exercise  any  agency  whatever  in  the  support  of  the 
body.  And  in  a  fracture  of  the  lower  jaw,  it  woiold  be  ob\dously 
futile  to  expect  it  to  contribute  materially  to  the  mastication  of 
food. 

A  fracture  seldom  occurs  which  is  not  accompanied  with  a 
degree  of  deformity,  greater  or  less,  of  the  region  or  the  leg 
affected.  This  is  due  to  the  exudation  of  the  blood  into  the 
meshes  of  the  surrounding  tissues  and  to  the  displacement  which 
occurs  between  the  fragments  of  the  bones,  with  subsequently 
the  swelling  which  follows  the  inflammation  of  the  surrounding 
tissues.  The  character  of  the  deformity  will  mainly  depend  upon 
the  manner  in  which  the  displacement  occurs. 

In  a  normal  state  of  things  the  legs  perform  their  movements 
with  the  joints  as  their  only  centres  or  bases  of  action,  wath  no 
participation  of  intermediate  points,  while  with  a  fractm'e  the 
flexibility  and  motion  which  will  be  observed  at  unnatural  points 
are  among  the  most  strongly  characteristic  signs  of  the  lesion. 
No  one  need  be  told  that  when  the  shaft  of  a  limb  is  seen  to  bend 
midway  between  the  joints,  with  the  lower  portion  swinging 
freely,  that  the  leg  is  broken.  But  there  are  still  some  conditions 
where  the  excessive  mobility  is  not  easy  to  detect  with  certainty. 
Such  are  the  cases  where  the  fracture  exists  in  a  short  bone,  near 
a  movable  joiut,  or  in  a  bone  of  a  region  where  several  short  and 
small  bones  are  united  in  a  group,  or  even  in  a  long  bone  where 
its  situation  is  such  that  the  muscular  covering  prevents  the 
visible  manifestation  of  the  symj)tom. 

If  the  situation  of  a  fractui'e  precludes  its  discovery  by  means 
of  this  abnormal  flexibiUty,  other  detective  methods  remain.  And 
after  all  there  is  one  decisive  sign  which,  though  it  may  not  avail 
in  every  case,  as  it  does  not,  is  in  cases  where  its  testimony  can 
be  secured  absolute  and  positive  beyond  question.  This  is  crep- 
itation, or  the  peculiar  effect  which  is  joroduced  by  the  friction 
of  the  fractured  surfaces  one  against  another.     Though  discerned 


FRACTURES.  217 

by  tlie  organ  of  hearing-,  it  can  scarcely  be  called  a  sound,  for  the 
grating  of  the  parts,  as  the  rubbing  takes  place,  is  often  more  felt 
than  heard,  but  thei-e  is  no  mistaking  its  import  in  cases  favorable 
for  the  apphcation  of  the  test.  The  conditions  in  which  it  is  not 
available  are  those  of  incomplete  fracture,  in  which  the  mobility 
of  the  i:)arts  is  lacking ;  and  those  in  which  the  whole  array  of 
phenomena  are  usually  obscure.  To  obtain  the  benefit  of  this 
pathognomonic  sign  requires  deliberate,  careful,  and  gentle  man- 
il^ulation.  Sometimes  the  slightest  movements  will  be  sufficient 
for  its  develoj)ment,  after  much  rougher  handling  has  failed  to 
discover  it.  Perhaj)s  the  failure  in  the  latter  case  is  due  to  a  sort 
of  defensive  spasmodic  rigidity  caused  by  the  pain  resulting  from 
the  rude  interference. 

More  or  less  reactive  fever  is  a  usual  accompaniment  of  a  frac- 
ture, and  an  ecchymosis  of  the  j)arts  is  but  a  natural  occurrence, 
more  easily  discovered  in  animals  possessing  a  light-colored  and 
delicate  skin  than  in  those  of  the  opposite  character. 

There  are  difficulties  in  the  way  of  the  diagnosis  of  an  incom- 
plete fracture,  even  sometimes  when  there  is  a  degree  of  impair- 
ment in  the  function  of  locomotion,  with  evidences  of  pain  and 
swelling  at  the  seat  of  lesion.  There  should  then  be  a  careful 
examination  for  the  evidences  of  a  blow  or  other  violence  sufficient 
to  account  for  the  fracture,  though  very  often  a  susj)icion  of  its 
existence  can  only  be  converted  into  a  certainty  by  a  minute  his- 
tory of  the  patient  if  it  can  be  obtained  up  to  the  moment  of  the 
occurrence  of  the  injury.  A  diagnosis  ought  not  to  be  hastily 
pronounced,  and  where  good  ground  for  suspicion  exists  it  ought 
not  to  be  rejected  upon  any  evidence  less  than  the  best.  Serious 
and  fatal  complications  are  too  often  recorded  of  the  results  fol- 
lowing careless  conclusions  in  similar  cases,  among  which  we  may 
refer  to  one  instance  of  a  complete  fracture  manifesting  itself  in 
an  animal  during  the  act  of  rising  up  in  his  stall  after  a  decision 
had  been  pronounced  that  he  had  no  fracture  at  all. 

Fractures  are  of  course  liable  to  comphcations,  those  esj)ecial- 
ly,  from  the  nature  of  the  case,  which  are  of  a  traumatic 
character,  such  as  extensive  lacerations,  tearing  of  tissues,  punc- 
tures, contusions,  etc.  But  unless  these  are  in  communication 
with  the  fracture  itself,  the  indication  is  to  treat  them  simply 
as  independent  lesions  uj)on  the  other  parts  of  the  body.  A 
traumatic  emphysema  will  at  times  cause  trouble,  and  abscesses, 


218  OPERATIONS    ON    BONES. 

more  or  less  deep  and  diffused,  may  follow.  In  some  cases  small 
bony  fragments  from  a  comminuted  fractm-e,  becoming  loose  and 
acting  as  foreign  bodies,  may  give  rise  to  troublesome  fistulous 
tracts.  A  frequent  complication  is  hemorrhage,  which  often  be- 
comes of  serious  consequence.  A  fracture  in  close  proximity  to  a 
joint  may  be  accompanied  by  dangerous  inflammations  of  im- 
jjortant  organs,  and  may  induce  an  attack  of  pneumonia,  pleurisy, 
arthritis,  etc.,  as  well  as  luxations  or  dislocations,  and  the  more 
so  if  situated  near  the  chest.  Gangrene,  as  a  consequence  of 
contusions  or  of  hemorrhage  or  of  an  impediment  to  the  cii'cula- 
tion,  caused  by  unskillfully  applied  apparatus,  must  not  be  over- 
looked among  the  occasional  incidents ;  nor  must  locJcjaw,  which 
is  not  an  uncommon  occurrence.  Even  laminitis  has  been  met 
with  as  the  result  of  forced  and  long-continued  immobihty  of  the 
feet  in  the  standing  posture,  as  one  of  the  involvements  of  una- 
voidably protracted  treatment. 

When  a  simple  fracture  has  been  properly  treated,  and  the 
broken  ends  of  the  bone  have  been  secm-ely  held  in  coaptation,  one 
of  two  things  will  occur.  Either — and  this  is  the  more  common 
event — there  will  be  a  union  of  the  two  ends  by  a  solid  cicatrix, 
the  callus,  or  the  ends  will  continue  separated  or  become  only 
partially  united  by  an  intermediate  fibrous  structure.  In  the 
first  instance  the  fracture  is  consohdated,  or  united,  in  the  second 
there  is  a  false  articulation,  or  2)seudo-arthrosis. 

The  time  required  for  a  firm  union  or  true  consolidation  of  a 
fracture  will  vary  with  the  character  of  the  bone  affected,  the  age 
and  constitution  of  the  patient,  and  the  general  condition  of  the 
case.  The  union  will  be  perfected  earlier  in  a  young  than  in  an 
adult  animal,  and  sooner  in  the  latter  than  in  the  aged,  and  a 
general  healthy  condition  is  of  course,  in  every  respect,  an 
advantage. 

The  mode  of  cicatrization,  or  method  of  repair  in  lesions  of 
the  bones,  has  been  a  subject  of  much  study  among  investigators 
in  pathology,  and  has  ehcited  various  expressions  of  opinion  from 
those  high  in  authority.  But  the  weight  of  evidence  and  pre- 
ponderance of  opinion  are  about  settled  in  favor  of  the  theory 
that  the  law  of  reparation  is  the  same  for  both  the  hard  and  the 
soft  tissues.  In  one  case  a  simple  exudation  of  material,  with  the 
proper  oi'ganization  of  newly  formed  tissue,  Avill  bring  about  a 
union  bv  the  first  intention,  and  in  another  the  work  will  be  ac- 


FRACTUKES. 


219 


companied  by  suppuration,  or  the  union  by  the  second  intention, 
a  process  so  familiar  in  the  repair  of  the  soft  structures  by 
granulation. 

Considering  the  process  in  its  simplest  form,  in  a  case  in  which 
it  advances  without  interruption  or  complication  to  a  favorable 
result,  it  may  probably  be  correctly  described  in  this  wise  : 

On  the  occiuTence  of  the  injury  an  effusion  of  blood  takes 
place  between  the  ends  of  the  bone.  The  coagulation  of  the  fluid  soon 
foUows,  and  this,  after  a  few  days,  undergoes  absorption.  There 
is  then  an  excess  of  inflammation  in  the  sm-rounding  structure,  which 
soon  spreads  to  the  bony  tissue,  when  a  true  ostitis  is  estabUshed, 
and  the  compact  tissue  of  the  bone  becomes  the  seat  of  a  new 
vascular  organization,  and  of  a  certain  exudation  of  plastic  lymph, 


Fig.  253.— Fracture  of  the  Common  Bone,  with  Callus. 


220  OPERATIONS    ON    BONES. 

appearing  between  the  periosteum  and  the  external  surface  of  the 
bone,  as  well  as  on  the  inner  side  of  the  medullary  cavity.  After 
a  few  days  the  ends  of  the  bone  thus  surrounded  by  this  exudate 
become  involved  in  it,  and  the  lymph,  becoming  vascular,  is  soon 
transformed  into  cartilaginous,  and  in  due  time  into  bony  tissue. 

Thus  the  time  required  for  the  consolidation  of  the  fractiu'ed 
segments  is  divisible  into  two  distinct  periods.  In  the  first  they 
are  surrounded  by  an  external  bony  ring,  and  the  medullary  ca\dty 
is  closed  by  a  bony  plug  or  stopper,  constituting  the  joeriod  of  the 
provisional  callus.  This  is  followed  by  the  period  of  perinanent 
callus,  during  which  the  process  is  going  forward  of  converting 
the  cartilaginous  into  the  osseous  form. 

The  restorative  process  is  sooner  completed  in  the  carnivorous 
than  in  the  herbivorous  tribes.  In  the  former  the  temporary  callus 
may  attain  sufficient  firmness  or  consistency  for  the  careful  use 
of  the  limb  within  four  weeks,  but  with  the  latter  a  period  of  from 
six  w^eeks  to  two  months  is  not  too  long  to  allow  before  removing 
the  supporting  apparatus  from  the  Hmb. 

This  in  general  terms  represents  the  fact  when  the  resources 
of  nature  have  not  been  thwarted  by  untoward  accidents,  such  as 
a  want  of  vigor  in  the  constitution  of  the  patient  or  a  lack  of  skill 
on  the  part  of  the  practitioner,  and  esjDecially  when,  from  any 
cause,  the  bony  fragments  have  not  been  kept  in  a  state  of  perfect 
immobility  and  the  constant  friction  has  prevented  the  osseous 
union  of  the  two  portions.  Failures  and  misfortunes  are  always 
more  than  possible,  and  instead  of  a  solid  and  practicable  bony 
union  the  sequel  of  the  accident  is  sometimes  a  false  Joint,  com- 
posed of  mere  flexible  cartilage,  a  -poor  2^seudo-arthrosis.  The  ex- 
planation of  this  appears  to  be  that,  first,  the  sharp  edges  of  the 
ends  of  the  bone  disappear  by  becoming  rounded  at  their  extrem- 
ities, by  friction  and  polishing  against  each  other.  Then  follows 
an  exvidation  of  a  plastic  nature,  which  becomes  transformed  into 
a  cartilaginous  layer  of  a  rough  articular  aspect.  In  this,  bony 
nuclei  soon  appear,  and  the  lymph  secreted  between  the  segments 
thus  transformed,  instead  of  becoming  truly  ossified,  is  changed 
into  a  sort  of  fibi'O-cartilaginous  pouch  or  capsular  sac,  in  which 
a  somewhat  albuminous  secretion,  or  pseudo-synovia,  permits  the 
movement  to  take  place.  Most  commonly,  however,  in  our 
animals,  the  union  of  the  bony  fi-agments  is  obtained  wholly 
through  the  medium  of  a  layer  of  fibrous  tissue,  and  it  is  because 


,  FEACTUKES.  221 

the  imion  has  been  accomplished  by  a  ligamentous  formation  only, 
that  motion  becomes  practicable. 

The  prognosis  in  a  case  of  fracture  in  an  animal  is  one  of  the 
gravest  vital  impoi't  to  the  patient,  and  therefore  of  serious  pecu- 
niary concern  to  his  owner.  The  period  has  not  long  elapsed 
when  to  have  received  such  a  hurt  was  quite  equivalent  to  under- 
going a  sentence  of  death  for  the  suffering  animal,  and  perhaps 
to-day  a  similar  verdict  is  pronounced  in  many  cases  in  which  the 
exercise  of  a  little  mechanical  ingenuity,  with  a  due  amoimt  of 
careful  nursing,  might  secure  a  contrary  result  and  insure  the  re- 
turn of  the  patient  to  his  former  condition  of  soundness  and  use- 
fulness. Considered  per  se,  a  fracture  in  an  animal  is  in  fact  no 
less  amenable  to  treatment  than  the  same  description  of  injury  in 
any  other  hving  being.  But  the  question  of  the  propriety  and 
expediency  of  treatment  is  dependent  upon  certain  specific  jjoints 
of  collateral  consideration. 

First.  The  nature  of  the  lesion  itself  is  a  point  of  paramount 
importance.  A  simple  fracture  occm-ring  in  a  bone  where  the 
ends  can  be  firmly  secured  in  coaptation,  presents  the  most  favor- 
able conditions  for  successful  treatment.  If  it  be  that  of  a  long 
bone  it  will  be  the  less  serious  if  situated  at  or  near  the  middle  of 
its  length  than  if  it  were  in  close  proximity  to  a  joint,  from  the 
fact  that  perfect  immobility  can  rarely,  in  the  latter  case,  be 
secured  without  incurring  the  risk  of  subsequent  rigidity  of  the 
joint. 

A  simjjle  is  always  less  serious  than  a  compound  fracture.  A 
comminuted  is  always  more  dangerous  than  a  simple,  and  a  trans- 
verse break  is  easier  to  treat  than  one  which  is  oblique.  The 
most  serious  are  those  which  are  situated  on  parts  of  the  body  in 
which  it  is  difficult  to  secure  perfect  immobility,  and  esi^ecially 
those  which  are  accompanied  by  severe  contusions  and  lacerations 
in  the  soft  parts  ;  the  protrusion  of  fragments  through  the  skin  ; 
the  division  of  blood  vessels  by  the  broken  ends  of  the  bone  ;  the 
existence  of  an  articulation  near  the  point  to  which  inflammation 
is  likely  to  extend ;  the  luxation  of  a  fragment  of  the  bone  ;  lacer- 
ation of  the  periosteum  ;  the  presence  of  a  large  number  of  bony 
particles,  the  result  of  the  crushing  of  the  bone — aU  these  are  cir- 
cumstances which  discourage  a  favorable  prognosis,  and  weigh 
against  the  hope  of  saving  the  patient  for  future  usefulness. 

Fractures  which  may  be  accounted  curable  are  those  which  are 


222 


OPERATIONS    ON    BONES. 


not  conspicuously  visible,  as  those  of  the  ribs,  where  displace- 
ments are  either  very  limited  or  do  not  occur,  the  parts  being  kej^t 
in  situ  by  the  nature  of  their  position,  the  shape  of  the  bones,  the 
articulations  they  form  with  the  vertebrae,  the  sternum,  or  their 
cartilages  of  prolongation ;  those  of  transverse  jDrocesses  of  the 
lumbar  vertebrae  ;  those  of  the  bones  of  the  face  ;  those  of  the  ili- 
um, and  that  of  the  coffin  bones.  To  continue  the  category,  they 
are  evidently  curable  when  their  position  and  the  character  of  the 
patient  contribute  to  aid  the  treatment.  Those  of  the  cranium, 
in  the  absence  of  cerebral  lesions ;  those  of  the  jaws,  of  the  ribs, 
with  displacement,  of  the  hip,  and  those  of  the  bone  of  the  leg  in 
movable  regions,  but  where  their  vertical  position  admits  of  per- 
fect coaptation. 

On  the  contrary,  a  compound,  complicated,  or  comminuted 
fracture,  in  whatever  region  it  may  be  situated,  may  be  accounted 
incurable. 

In  treating  fractures,  time  is  an  important  element  and  "  de- 
lays are  dangerous."  Those  of  recent  occurrence  unite  more  easi- 
ly and  more  regularly  than  older  ones. 

Second.  As  a  general  rule,  fractures  are  less  serious  in  animals 
of  the  smaller  species  than  in  those  of  more  bulky  dimensions. 
This  influence  of  sjiecies  will  be  readily  appreciated  when  we  real- 
ize that  the  difficulties  involved  in  the  treatment  of  the  latter  class 
have  hardly  any  existence  in  connection  with  the  former.  The 
difference  in  weight  and  size,  and  consequent  facility  in  handling, 
and  making  the  necessary  applications  of  dressings  and  other  aji- 
pHances  for  the  purj)ose  of  securing  the  indisjDensable  immobility 
of  the  parts,  and  usually  a  less  degree  of  uneasiness  in  the  de- 
portment of  the  patients  are  considerations  in  this  connection  of 
great  weight. 

Third.  In  respect  to  the  utilization  of  the  animal,  the  most 
obvious  point  in  estimating  the  gra^'ity  of  the  case  in  a  fracture 
accident  is  the  certainty  of  the  total  loss  of  the  services  of  the  pa- 
tient dm-ing  treatment — certainly  for  a  considerable  period  of 
time,  perhaps  permanently.  For  example,  the  fracture  of  the  jaw 
of  a  steer  just  fattening  for  the  shambles  will  involve  a  heavier 
loss  than  a  similar  accident  to  a  horse.  Usually  the  fracture  of 
the  bones  of  the  extremities  in  a  horse  is  a  very  serious  casualty, 
the  more  so  proportionately  as  the  higher  region  of  the  limb  is 
affected.     In  working  animals  it  is  exceedingly  difficult  to  treat  a 


FRACTUllf:S.  223 

fracture  in  such  a  manner  as  to  restore  a  limb  to  its  original  per- 
fection of  movement.  A  fracture  of  a  single  bone  of  an  extremity 
in  a  breeding  stallion  or  mare  will  not  necessarily  impair  tbeii* 
value  as  breeders.  Other  specifications  under  this  head,  though 
pertinent  and  more  or  less  interesting,  may  be  omitted. 

Fourth.  Age  and  temper  are  important  factors  of  cure.  A 
young,  growing,  robust  patient,  whose  vis  vitm  is  active,  is  amen- 
able to  treatment  which  one  with  a  waning  constitution  and  past 
mature  energies  would  be  unable  to  endure,  and  a  docile,  quiet 
disposition  will  act  co-operatively  with  remedial  measures  which 
Avould  be  neutralized  by  the  fractious  opposition  of  a  peevish  and 
intractable  sufferer. 

The  fulfillment  of  three  indications  is  indispensable  in  all  frac- 
tures. The  first  is  the  reduction,  or  the  replacement  of  the  parts 
as  nearly  as  possible  in  their  normal  position.  The  second  is  theii* 
retention  in  that  position  for  a  period  sufficient  for  the  formation 
of  the  provisional  callus,  and  the  third,  which  in  fact  is  but  an  in- 
cident of  the  second,  the  careful  avoidance  of  any  accidents  or 
causes  of  miscarriage  which  might  disturb  the  curative  process. 

In  reference  to  the  first  consideration,  it  must  be  remembered 
that  the  accident  may  befall  the  patient  at  a  distance  from  his 
home,  and  his  removal  becomes  the  first  duty  to  be  attended  to. 
Of  course  this  must  be  done  as  carefully  as  possible.  If  he  can 
be  treated  on  the  spot  so  much  the  better,  though  this  is  seldom 
practicable,  and  the  method  of  removal  becomes  the  question  call- 
ing for  settlement.  But  two  ways  present  themselves — he  must 
either  walk  or  be  carried.  If  the  first,  it  is  needless  to  say  that 
every  caution  must  be  observed  in  order  to  obviate  any  additional 
pain  for  the  suffering  animal,  and  to  avoid  any  aggravation  of  the 
injury.  Led  slo\vly,  and  with  j^artial  support  if  j^racticable,  the 
journey  will  not  always  involve  untoward  results.  If  he  is  carried 
it  must  be  by  means  of  a  wagon,  a  truck,  or  an  ambulance ;  the 
latter  being  designed  and  adapted  to  the  pm-jjose,  would,  of 
course,  be  the  preferable  vehicle.  As  a  precaution  which  should 
never  be  overlooked,  a  temporary  dressing  should  first  be  applied. 
This  may  be  so  done  as  for  the  time  to  answer  all  the  purpose  of 
the  permanent  adjustment  and  bandaging.  "Without  thus  secur- 
ing the  patient,  a  fracture  of  an  inferior  degree  may  be  trans- 
formed to  one  of  the  severest  kind,  and,  indeed,  a  curable  changed 
to  an  incurable  injury.     We  recall  a  case  in  which  a  fast  trotting 


224:  OPERATIONS    ON    BONES. 

horse,  after  running  away  in  a  fright  caused  by  the  whistle  of  a 
locomotive,  was  found  on  the  road  limping  with  excessive  lame- 
ness in  the  off  fore  leg,  and  walked  with  comparative  ease  some 
two  miles  to  a  stable  before  being  seen  by  a  surgeon.  His  imme- 
diate removal  in  an  ambulance  was  advised,  but  before  that  vehi- 
cle could  be  procured  the  horse  laid  down,  and  upon  being  made 
to  get  upon  his  feet  was  found  with  a  well-marked  comminuted 
fracture  of  the  os  suffraginis,  with  considerable  displacement. 
The  patient,  however,  after  long  treatment,  made  a  comparatively 
good  recovery,  and  though  with  a  large  bony  dej^osit,  a  ringbone, 
was  able  to  trot  among  the  forties. 

The  two  obvious  indications  in  cases  of  fracture  are  reduction, 
or  replacement  and  retention. 

In  an  incomplete  fracture,  where  there  is  no  displacement,  the 
necessity  of  reduction  does  not  exist.  With  the  bone  kept  in 
place  by  an  intact  periosteum,  and  the  fragments  secured  by  the 
uninjured  fibrous  and  ligamentous  structure  which  surrounds 
them,  there  is  no  dislocation  to  correct.  It  is  also  at  times  ren- 
dered imjDOSsible  by  the  seat  of  the  fracture  itself,  by  its  dimensions 
alone,  or  by  the  resistance  arising  from  the  muscular  contraction 
excited  by  the  surgical  manipulation.  This  is  illustrated  even  in 
small  animals,  as  in  dogs,  by  the  exceeding  difficulty  encountered 
in  bringing  the  ends  of  a  broken  femur  or  humerus  together,  the 
muscular  contraction  being  even  in  these  animals  sufficiently  for- 
cible to  renew  the  disi^lacement. 

It  is  generally,  therefore,  only  fractures  of  the  long  bones,  and 
then  at  2:)oints  not  in  close  proximity  to  the  trunk,  that  may  be  con- 
sidered to  be  amenable  to  reduction.  It  is  true  that  some  of  the 
more  superficial  bones,  as  those  of  the  head,  of  the  pelvis,  and  of 
the  thoracic  walls  may  in  some  cases  require  special  manipulations 
and  appliances  for  their  retention  in  their  normal  positions,  but 
the  treatment  of  these  and  of  a  fractured  leg  cannot  be  the  same. 

The  methods  of  accomplishing  reduction  vary  with  the  features 
of  each  case,  the  manij^ulations  being  necessarily  modified  to  meet 
changing  circumstances.  If  the  dis^Dlacement  is  in  the  thickness 
of  the  bone,  as  in  transverse  fracture,  the  manipulation  of  reduc- 
tion consists  in  applpng  a  steady  pressm-e  vij)on  one  of  the  frag- 
ments, while  the  other  is  kept  steady  in  its  place,  the  object  of  the 
l^ressure  being  the  re-establishment  of  the  exact  coincidence  of  the 
two  bony  surfaces.     If  the  displacement  has  taken  place  at  an 


FRACTURES.  225 

angle  it  will  be  siifficient  in  order  to  effect  the  reduction  to  press 
upon  the  summit  or  ajiex  of  the  angle  until  its  disai^ijearance  in- 
dicates that  the  parts  have  been  brought  into  coaptation.  This 
method  is  often  practiced  in  the  treatment  of  a  fractured  rib.  In 
a  longitudinal  fracture,  or  when  the  fragments  are  pressed  together 
by  the  contraction  of  the  muscles  to  which  they  give  insertion 
until  they  so  overlap  as  to  correspond  by  certain  points  of  their 
circumference,  the  reduction  is  to  be  accomplished  by  effecting 
the  movements  of  extension,  counter-extension,  and  coaptation. 
Extension  is  accomphshed  by  making  traction  uj^on  the  lower  por- 
tion of  the  limb.  Counter-extension  consists  in  firmly  holding  or 
confining  the  upper  or  body  portion  in  such  a  manner  that  it 
shall  not  be  affected  by  the  traction  ai^i^lied  to  the  lower;  in  sim- 
pler language,  holding  it  motionless  against  the  force  exercised  in 
the  extension.  In  other  words,  the  oj^erator,  grasping  the  limb 
below  the  fractiu'e,  draws  it  down  or  away  from  the  trunk,  while 
he  seeks,  not  to  draw  away,  but  simply  to  hold  still  the  upper  por- 
tion until  the  broken  ends  of  bone  are  brought  to  their  natural 
relative  positions  when  the  coaptation,  which  is  thus  affected,  has 
only  to  be  made  permanent  by  the  proper  dressings  to  perfect  the 
reduction. 

In  treating  fractures  in  small  animals  the  strength  of  the  hand ' 
is  usually  sufficient  for  the  required  manipulations.  In  the  fracture 
of  a  forearm  of  a  dog,  for  example,  while  the  uj^per  segment  is 
firmly  held  by  one  hand,  the  lower  may  be  grasped  by  the  other 
and  the  bone  itself  made  to  serve  the  purpose  of  a  lever  to  brin<>' 
about  the  desired  coaptation.  In  such  a  case  that  is  sufficient  to 
overcome  the  muscular  contraction  and  correct  the  overlapping  or 
other  malposition  of  the  bones.  If,  however,  the  resistance  can 
not  be  overcome  in  this  mode,  the  upper  segment  may  be  committed 
to  an  assistant  for  the  management  of  the  counter  extension, 
leaving  to  the  operator  the  free  use  of  both  hands  for  the  further 
manipulation  of  the  case. 

But  if  the  reduction  of  fractures  in  small  animals  is  an  easy 
task  it  is  far  from  being  so  when  a  large  animal  is  the  patient, 
whose  muscular  force  is  largely  greater  than  that  of  several  men 
combined.  In  such  a  case  resort  must  be  had  not  only  to  superior 
numbers  for  the  necessary  force,  but  in  many  cases  to  mechanical 
aids.  A  reference  to  the  mode  of  proceeding  in  a  case  of  fracture 
with   displacement  of  the  forearm  of  a  horse  will  illustrate  the 


226  OPEEATIONS    ON    BONES. 

matter.  The  patient  is  first  to  be  carefully  cast,  on  the  uninjured 
side,  with  ropes,  or  a  broad  leather  strap  about  18  feet  long,  ^^assed 
under  and  around  his  body  and  under  the  axilla  of  the  fractm-ed 
limb  and  secured  at  a  point  opjiosite  to  the  animal  and  toward  his 
back.  This  will  form  the  mechanical  means  of  counter  extension. 
Another  roj^e  will  then  be  placed  around  the  inferior  part  of  the 
leg  below  the  point  of  fracture,  with  which  to  j^roduce  extension, 
and  this  wiU  sometimes  be  furnished  with  a  block  or  pulleys,  in 
order  to  augment  the  power  when  necessary ;  and  there  is,  in  fact, 
alwaj'S  an  advantage  in  their  use,  on  the  side  of  steadiness  and 
uniformity,  as  well  as  of  increased  power.  It  is  secured  around 
the  fetlock  or  the  coronet,  or,  what  is  better,  above  the  knee  and 
nearer  the  point  of  fracture,  and  is  committed  to  assistants.  The 
traction  on  this  should  be  firm,  uniform,  and  slow,  without  relaxing 
or  jerking,  while  the  operator  carefully  watches  the  process.  If 
the  bone  is  superficially  situated  he  is  able  to  judge,  by  the  eye,  of 
any  changes  that  may  occur  in  the  form  or  length  of  the  parts 
under  traction,  and  discovering  at  the  moment  of  its  hapj^ening 
the  restoration  of  sj^mmetry  in  the  disturbed  region,  he  gently  but 
firmly  manipulates  the  place  imtil  all  apj^earance  of  severed  con- 
tinuity have  vanished.  Sometimes  the  fact  and  the  instant  of  res- 
toration are  indicated  by  a  pecuhar  sound,  or  "  click,"  as  the  ends 
of  the  bone  shp  into  contact,  to  await  the  next  step  of  the  restora- 
tive procedure. 

The  25rocess  is  the  same  when  the  bones  are  covered  with  thick 
muscular  masses,  excepting  that  it  is  attended  with  greater  diffi- 
cidties,  from  the  fact  that  the  finger  must  be  substituted  for  the 
eye,  and  the  taxis  must  take  the  place  of  the  sight,  and  the  result 
natm-aUy  becomes  more  uncertain. 

It  frequently  happens  that  perfect  coaptation  is  prevented  by 
the  interposition  between  the  bony  surfaces  of  substances,  such  as 
a  small  fragment  of  detached  bone  or  a  clot  of  blood,  and  some- 
times the  extreme  obhquity  of  the  fracture  is  the  opposing  cause, 
by  permitting  the  bones  to  slip  out  of  x^lace.  These  are  difficulties 
which  can  not  always  be  overcome,  even  in  smaU-sized  animals, 
and  still  it  is  only  when  they  are  mastered  that  a  correct  consoH- 
dation  can  be  looked  for.  Yet  without  it  the  continuity  between 
the  fragments  will  be  by  a  deformed  callus,  the  union  will  leave  a 
shortened,  crooked  or  angular  Hmb,  and  a  disabled  animal. 

If  timely  assistance  can  be  obtained,   and  the  reduction  ac- 


FEACTURES.  227 

complished  immediately  after  the  occurrence  of  the  accident,  that 
is  the  best  time  for  it.  But  if  it  cannot  be  attended  to  until  in- 
flammation has  become  established  and  the  parts  have  become 
swollen  and  painful,  time  must  be  allowed  for  the  subsidence  of 
these  sj-mptoms  before  attempting  the  operation.  A  spasmodic 
muscular  contraction,  which  sometimes  interjooses  a  difficulty,  may 
be  easily  overcome  by  subjecting  the  patient  to  general  anesthesia, 
and  need  not,  therefore,  cause  any  loss  of  time.  A  tendency  to 
this  may  also  be  overcome  by  the  use  of  sedatives  and  anti-phlo- 
gistic remedies. 

The  reduction  of  the  fracture  having  been  accomplished,  the 
problem  which  follows  is  that  of  retention.  The  parts  which  have 
been  restored  to  their  natural  position  must  be  kept  there,  with- 
out disturbance  or  agitation,  until  the  perfect  formation  of  a  callus, 
and  it  is  here  that  ample  latitude  exists  for  the  exercise  of  ingen- 
uity and  skill  by  the  surgeon  in  the  contrivance  of  the  necessary 
apparatus.  One  of  the  most  important  of  the  conditions  which 
are  available  by  the  surgeon  in  treating  human  patients  is  denied 
the  veterinarian  ia  the  management  of  those  which  belong  to 
the  animal  tribes.  This  is  2)ositlon.  The  intelligence  of  the 
human  patient  co-operates  with  the  instructions  of  the  surgeon, 
but  with  the  animal  sufferer  there  is  a  continual  antagonism 
between  the  parties,  and  the  forced  extension  and  fatiguing  posi- 
tion which  must  for  a  considerable  period  be  maintained  as  a  con- 
dition of  restoration  require  special  and  effective  appliances  to 
insure  successful  results.  To  obtain  complete  immobility  is 
scarcely  possible,  and  the  surgeon  must  be  content  to  reach  a 
point  as  near  as  possible  to  that  which  is  unattainable.  For  this 
reason,  as  will  subsequently  be  seen,  the  use  of  slings  and  the  re- 
straint of  patients  in  very  narrow  stalls  is  much  to  be  preferred  to 
the  practice  sometimes  recommended,  of  allowing  entire  freedom  of 
motion  by  turning  them  loose  in  box  stalls.  Temporary  and  mova- 
ble apparatus  are  not  usually  of  difficult  use  in  veterinary  j^i-actice, 
but  the  restlessness  of  the  patients  and  their  unwilhngness  to 
submit  quietly  to  the  changing  of  the  dressings  render  it  obliga- 
tory to  have  recourse  to  permanent  and  immovable  bandages, 
which  shovild  be  retained  without  disturbance  until  the  process  of 
consolidation  is  complete. 

The  materials  composing  the  retaining  apparatue  consist  of 
oakum,  bandages  and  spHnts,  with  an  agglutinating  compound 


228  OPEKATIOXS    ON    BONES. 

which  forms  a  species  of  cement  by  which  the  different  constit- 
uents are  blended  into  a  consistent  mass  to  be  spread  upon  the 
surface  covering  the  locahty  of  the  fracture.  Its  components  are 
black  pitch,  resin,  and  Venice  turpentine,  blended  by  heat.  The 
dressing  may  be  applied  du'ectly  to  the  skin,  or  a  covering  of  thin 
linen  may  be  interposed.  A  putty  made  with  powdered  chalk 
and  the  white  of  an  egg  is  recommended  for  small  animals,  though 
a  mixture  of  sugar  of  lead  and  burnt  alum  with  the  albumen  is 
preferred  by  others.  Another  formula  is  spirits  of  camphoi', 
Goulard's  extract  and  albumen.  Another  recommendation  is  to 
saturate  the  oakum  and  bandages  with  an  adhesive  solution  formed 
with  gum  arable,  dextrine,  flour  paste,  or  starch.  This  is  advised 
particularly  for  small  animals.  Dextrine  mixed,  while  warm,  with 
burnt  alum  and  alcohol  cools  and  sohdifies  into  a  stony  consistenc}', 
and  is  preferable  to  plaster  of  Paris,  which  is  less  friable  and  has 
less  solidity,  besides  being  heavier  and  reqvuring  constant  additions 
as  it  becomes  older.  Starch  and  plaster  of  Paris  form  another 
good  compoimd. 

In  applying  the  dressing  the  leg  is  usually  padded  with  a 
cushion  of  oakum,  thick  and  soft  enough  to  equalize  the  irregu- 
larities of  the  surface  and  to  form  a  bedding  for  the  protection  of 
the  skin  from  chafing.  Over  this  the  splints  are  placed.  The 
material  for  these  is,  variously,  pasteboard,  thin  wood,  bark,  laths, 
gutta  percha,  strips  of  thin  metal,  as  tin  or  perhaps  sheet  iron. 
These  should  be  of  sufficient  length  not  only  to  cover  the  region 
of  the  fracture,  but  to  extend  sufficiently  above  and  below  to 
render  the  immobility  more  complete  than  in  the  surrounding 
joints.  The  spHnts  again,  are  covered  with  cloth  bandages,  linen 
preferably,  soaked  in  a  glutinous  moisture.  These  bandages  are 
to  be  carefully  appHed,  with  a  perfect  condition  of  lightness. 
They  are  usually  made  to  embrace  the  entire  length  of  the  leg,  in 
order  to  avoid  the  possibihty  of  interference  with  the  circulation 
of  the  extremity,  as  well  as  for  the  prevention  of  chafing.  They 
should  be  rolled  from  the  lower  part  of  the  leg  upward,  and 
carefully  secured  against  loosening.  In  some  instances  suspen- 
sory bandages  are  recommended,  but  excepting  for  small  animals 
our  experience  does  not  justify  a  concurrence  in  the  recommen- 
dation. 

These  permanent  dressings  always  need  careful  watching  in 
reference  to  then-  immediate  effect  upon  the  region  they  cover. 


FRACTURES.  229 

especially  during  the  first  days  succeeding  that  of  their  appHca- 
tion.  Any  manifestation  of  pain,  or  any  appearance  of  swelling- 
above  or  below,  or  any  odor  suggestive  of  supjouration  should 
excite  suspicion,  and  a  thorough  investigation  should  follow  with- 
out delay.  The  removal  of  the  dressing  should  be  performed 
with  great  care,  and  especially  so  if  time  enough  has  elapsed  since 
its  apphcation  to  allow  of  a  probability  of  a  commencement  of  the 
healing  process  or  the  existence  of  any  points  of  consoHdation. 
"With  the  original  dressing  properly  applied  in  its  entirety  in  the 
first  instance,  the  entu'e  extremity  will  have  lost  all  chance  of 
mobility,  and  the  repaii'ing  process  may  be  permitted  to  proceed 
without  interference.  There  will  be  no  necessity  and  there  need 
be  no  haste  for  removal  or  change  except  under  such  special  con- 
ditions as  have  just  been  mentioned,  or  when  there  is  reason  to 
judge  that  solidification  has  become  perfect,  or  for  the  comfort  of 
the  animal,  or  for  its  readaptation  in  consequence  of  the  atrophy 
of  the  limb  from  want  of  use.  Owners  of  animals  are  often 
tempted  to  remove  a  splint  or  bandage  prematurely  at  the  risk  of 
producing  a  second  fracture  in  consequence  of  the  failure  of  the 
callus  properly  to  consolidate. 

The  method  of  applying  the  splints  which  we  have  described 
refers  to  the  simple  variety  only.  In  a  compound  case  the  same 
rules  must  be  observed,  with  the  modification  of  leaving  openings 
through  the  thickness  of  the  dressing,  opposite  the  wound,  in 
order  to  permit  the  escape  of  pus  and  to  secure  access  to  the 
points  requiring  the  application  of  treatment. 

Fracture  of  different  Bones. 
Of  the  Cranial  Bones. — Fractures  of  this  variety  in  large 
animals  are  comparatively  rare,  though  the  records  are  not  desti- 
tute of  cases.  AVhen  they  occur,  it  is  as  the  result  of  external 
violence,  the  sufierers  being  usually  runaways  which  have  come  in 
coUision  with  a  wall  or  tree,  or  other  obstruction ;  or  it  may  occur 
in  those  which  in  pulling  upon  the  halter  have  broken  it  with  a 
jerk  and  been  thi-own  backward,  as  might  occur  in  rearing  too 
violently.  Under  these  conditions  we  have  witnessed  fractui-es  of 
the  parietal,  of  the  frontal,  and  of  the  sphenoid  bones.  These 
fractures  may  be  of  the  complete  or  incomplete  kind,  which  in- 
deed is  usually  the  case  with  those  of  the  flat  bones,  and  they  are 
liable  to  be  comjoHcated  with  lacerations  of  the  skin,  in  conse- 


230 


OPERATIONS    ON   BONES. 


quence  of  which  they  are  easily  brought  under  observation.  But 
when  the  fact  is  otherwise  and  the  skin  is  intact,  the  diagnosis 
becomes  difficult.  The  incomplete  variety  may  be  unaccompanied 
by  any  special  symptoms,  but  in  the  complete  kind  one  of  the 
bony  plates  may  b^  so  far  detached  as  to  j^ress  upon  the  cerebral 
substance  with  sufficient  force  to  produce  serious  nervous  com- 
phcations.  "WTien  the  injury  occurs  at 
the  base  of  the  cranium,  hemorrhage  may 
be  looked  for,  with  paralj'tic  symptoms, 
and  when  these  are  present  the  usual  ter- 
mination is  death.  It  may  still  haj)j)en, 
however,  that  the  symptoms  of  an  appa- 
rently very  severe  concussion  may  dis- 
appear, with  the  result  of  an  early  and 
complete  recovery,  and  the  surgeon  vdll 
do  well  to  avoid  undue  precipitation  in 
venturing  upon  a  prognosis.  In  frac- 
tures of  the  orbital  or  the  zygomatic 
bones  the  danger  is  less  pressing  than 
with  injuries  otherwise  located  about  the 
head.  The  treatment  of  cranial  fractures 
is  simple,  though  invohdng  the  best  skill 
of  the  experienced  surgeon.  "When  in- 
complete, hardly  any  interference  is  need- 
ed ;  even  plain  bandaging  may  usually 
be  dispensed  with.  In  the  comj)lete  va- 
riety the  danger  to  be  combated  is  com- 
pression of  the  brain,  and  attention  to 
this  indication  must  not  be  delayed.  The 
Fig.  254.-Apparatu8  for  Frac-  j^g^ns  to  be  employed  are  the  trephinmg 

ture  of  the  Nasal  Bone.  ^    /  ■,       o 

of  the  skull  over  the  seat  of  the  fracture, 
and  the  elevation  of  the  depressed  bone  or  the  removal  of  the  por- 
tion which  is  causing  the  trouble.  Fragments  of  bone  in  commin- 
uted cases,  exfoliations,  collections  of  fluid,  or  even  protruding 
portions  of  the  brain  substance  must  be  cleansed  away,  and  a 
simple  bandage  so  appUed  as  to  facilitate  the  appHcation  of  sub- 
sequent dressings. 

/fractures  of  the  Hones  of  the  Face. — In  respect  to  their  origin — 
usually  traumatic — these  injuries  rank  with  the  preceding,  and  are 
commonly  of  the  incomplete  variety.     They  may  easily  be  over- 


FRACTURES. 


231 


looked  and  may  even  sometimes  escape  recognition  until  the  rep- 
arative process  has  been  weU  estabhshed  and  the  discovery  of  the 
v\round  becomes  due  to  the  prominence  caused  by  the  presence  of 
the  provisional  caUus  which  marks  its  cure.  When  the  fractiu-e  is 
complete  it  will  be  marked  by  local  deformity,  mobiHty  of  the 
fragments,  and  crepitation.  Nasal  hemorrhage,  roaring,  frequent 
sneezing,  loosening  or  loss  of  teeth,  difficulty  of  mastication,  and 
inflammation  of  the  cavities  of  the  sinuses  are  varying  complica- 
tions of  these  accidents.  The  object  of  the  treatment  should  be 
the  restoration  of  the  depressed  bones  as  nearly  as  possible  to 
their  normal  position,  and  their  retention  in  place  by  protecting 
splints,  which  should  cover  the  entire  facial  region  (Figs.  254,  255), 


Fig.  255.— Apparatus  for  Fracture  of  the  Bones  of  the  Pace  Applied. 

and  special  precautions  should  be  observed  to  prevent  the  patient 
from  disturbing  the  dressing  by  rubbing  his  head  against  sur- 
rounding objects,  such  as  the  staU,  the  manger,  the  rack,  etc. 
Clots  of  blood  in  the  nasal  passages  must  be  washed  out,  collec- 
tions of  pus  must  be  removed  from  the  sinuses,  and  if  the  teeth 
are  loosened  and  likely  to  fall  out,  they  should  be  removed.  If 
roaring  is  threatened,  tracheotomy  is  indicated. 

Fractures  of  the  F re-Maxillary  Bone. — These  are  mentioned 
by  continental  authors.  They  are  usually  encountei'ed  in  connec- 
tion with  fractures  of  the  nasal  bone,  and  may  take  place  either 
in  the  width  or  length  of  the  bone. 

The  deformity  of  the  upper  lip,  which  is  di'awn  sideways  in 


232  OPEKATIONS    ON    BONES. 

this  lesion,  renders  it  easy  of  diagnosis.  The  abnormal  mobility 
and  the  crei^itation,  with  the  pain  manifested  by  the  patient  when 
undergoing-  examination,  are  concuri'ent  symptoms.  Looseness 
of  the  teeth,  abundant  salivation,  and  entu-e  inability  to  grasp  the 
food  complete  the  symptomatology  of  these  accidents.     In  the 


Fig.  256.— Fracture  of  the  Lower  Jaw. 

treatment,  splints  of  gutta  percha  or  leather  are  sometimes  used, 
but  they  are  of  difficult  application.  Our  own  judgment  and 
practice  are  in  favor  of  the  union  of  the  bones  by  means  of  metallic 
sutures. 

The  Loioer  Jaw. — A  fracture  here  is  not  an  injury  of  infrequent 
occiirrence.  It  involves  the  body  of  the  bone,  at  its  symphysis,  or 
back  of  it,  and  includes  one  or  both  of  its  branches,  either  more 
or  less  forward,  or  at  the  posterior  part,  near  the  temporo-max- 
illary  articulation,  at  the  coronoid  process. 

Falls,  blows,  or  other  external  violence,  or  powerful  muscular 
contractions  during  the  use  of  the  speculum,  may  be  mentioned 
among  the  causes  of  this  lesion.  The  fracture  of  the  neck  and  of 
the  branches  in  front  of  the  cheeks  cause  the  lower  jaw,  the  true 
dental  arch,  to  drop  without  the  ability  to  raise  it  again  to  the 
upper,  and  the  result  is  a  peculiar  and  characteristic  physiognomy 
(Fig.  256.)  The  prehension  and  mastication  of  food  become  im- 
possible; there  is  an  abundant  escape  of  fetid  and  sometimes 
bloody  saliva,  especially  if  the  gums  have  been  wounded ;  there  is 
excessive  mobility  of  the  lower  end  of  the  jawbone  ;  and  there  is 


FRACTURES. 


233 


Fig.  257.— Splint  for  Fracture  of  the  Lower  Maxillary. 

crepitation,  and  frequently  paralysis  of  the  under  lip.  But  al- 
though the  aspect  of  an  animal  suffering  mth  a  complete  and 
often  compound  and  comminuted  fracture  of  the  submaxilla  pre- 
sents at  times  a  frightful  spectacle,  the  prognosis  of  the  case  is 
comparatively  simple,  and  recovery  usually  only  a  question  of 
time.  The  severity  of  the  lesion  corresponds  in  degree  with  that 
of  the  violence  to  which  it  is  due,  the  degree  of  simphcity  or  the 
amoiint  of  compUcation,  and  with  the  situation  of  the  wound.  It 
is  simple  when  at  the  symphysis,  but  becomes  more  serious  when 
it  affects  one  of  the  branches,  to  be  again  aggravated  when  both 
are  involved.  Fracture  of  the  coronoid  process  becomes  import- 
ant princij)ally  as  an  evidence  of  the  existence  of  a  morbid  diathe- 
sis, such  as  osteoporosis,  or  the  like. 

The  particular  seat  of  the  injury,  with  its  special  features,  will 
of  course  determine  the  treatment.  For  a  simple  fracture  without 
displacement,  provided  there  is  no  laceration  of  the  periosteum, 
an  ordinary  supporting  bandage  will  usually  be  sufficient.  But 
when  there  is  displacement  the  reduction  of  the  fracture  must  first 
be  accomphshed,  and  for  this  special  splints  are  necessary.  In  a 
fracture  of  the  symphysis  or  of  the  branches  the  adjustment  of  the 
fragments  by  securing  them  with  metallic  sutures  is  the  first  step 
necessary,  to  be  followed  by  the  appHcation  of  supports,  consisting 
of  sphnts  of  leather  or  sheets  of  metal  (Fig.  258  and  259),  the  entu-e 


234 


OPERATIONS    ON    BONES. 


Fig  25^  — ^i  liiit,  l(ji  1  idLture  of  the  Branches. 

front  of  the  head  being  then  covered  with  bandages  prepared  with 
adhesive  mixtures.  During  the  entire  course  of  treatment  a  special 
method  of  feeding  becomes  necessary.  The  inability  of  the  patient 
to  appreciate  the  situation  of  course  necessitates  a  resort  to  an 
artificial  mode  of  introducing  the  necessary  food  into  his  stom- 
ach, and  it  is  accomplished  by  forcing  between  the  commissures 
of  the  lips,  in  a  hquid  form,  by  means  of  a  syringe,  the  milk  or 


Another  Splint  foi-  Fracture  of  the  Maxillary. 


FRACTURES.  235 

nutritive  gruels  selected  for  liis  sustenance,  until  the  consolidation 
is  sufficiently  advanced  to  permit  the  ingestion  of  food  of  a  more 
solid  consistency.  The  callus  will  usually  be  sufficiently  hardened 
in  two  or  three  weeks  to  allow  of  a  change  of  diet  to  mashes  of 
cut  hay  and  scalded  grain,  until  the  removal  of  the  dressing  re- 
stores him  to  his  old  habit  of  mastication. 

Fractures  of  vertebrm. — These  are  not  very  common,  but  when 
they  do  occur  the  bones  most  frequently  injured  are  those  of  the 
back  and  loins.  The  ordinary  causes  of  fracture  are  responsible 
here  as  elsewhere,  such  as  heavy  blows  on  the  spinal  column,  severe 
falls  while  conveying  heavy  loads,  and  especially  violent  efforts  in 
resisting  the  process  of  casting.  Although  occurring  more  or  less 
frequently  under  the  latter  circumstances,  the  accident  is  not  always 
attributable  to  carelessness  or  error  in  the  management.  It  mav 
of  course,  sometimes  result  from  such  a  cause  as  a  badly  prejDared 
bed,  or  the  accidental  presence  of  a  hard  body  concealed  in  the 
straw,  or  to  a  heavy  fall  when  the  movements  of  the  patient  have 
not  been  sufficiently  controlled  by  an  effective  apparatus  and  its 
skillful  adaptation,  but  it  is  quite  as  likely  to  be  caused  by  the 
violent  resistance  and  the  consequent  powerful  muscular  contrac- 
tion by  the  frightened  patient.  The  sim- 
ple fact  of  the  overarching  of  the  vertebral 
column,  with  excessive  pressure  against 
it  from  the  intestinal  mass,  owing  to  the 
spasmodic  action  of  the  abdominal  mus- 
cles, may  account  for  it,  and  so  also  may 
the  struggles  of  the  animal  to  escape  from 
the  restraint  of  the  hobbles  while  frantic 
under  the  pain  of  an  operation  without 
anaesthesia.  In  these  cases  the  fractui-e 
usually  occm-s  in  the  body  or  the  annular 
part,  or  both,  of  the  posterior  dorsal  or 
FiG.sfio.-Fiactureof  the  Body  the  anterior  lumbar  vertebra.  AATien  the 
of  a  Dorsal  Vertebra,.  ^inverse    processes    of    the    last-named 

bones  are  injured,  it  is  probably  in  consequence  of  heavy  concus- 
sion incident  to  striking  the  ground  when  cast.  Diagnosis  of  a 
fracture  of  the  body  of  a  vertebra  is  not  always  easy,  especially 
when  quite  recent,  and  more  especially  when  there  is  no  accom- 
panying displacement.  There  are  certain  pecuHar  signs  accom- 
panjdng  the  occurrence  of  the  accident  while  an  operation  is  in 


236 


OPERATIONS    ON    BONES. 


Fig.  261a.— Comminuted  Fracture  of  a  Dor- 
sal VertetoriJB  at  the  Annular  Portion. 


Fig.  261.— United  Fracture  of  the  Spi- 
nous Processes  of  Dorsal  Vertebrae. 

progress  which  should  at  once  excite  the  suspicion  of  the  surgeon. 
In  the  midst  of  a  -sdolent  struggle  the  patient  becomes  suddenly 
quiet ;  the  movement  of  a  sharp  instrument  which  at  first  excited 
his  resistance  fails  to  give  rise  to  any  further  evidence  of  sensation ; 
perhaps  a  general  trembling,  lasting  for  a  few  minutes,  will  follow, 
succeeded  by  a  cold,  profuse  perspii'ation,  particularly  between 
the  hind  legs,  and  frequently  there  will  be  mictvmtion  and  defe- 
cation. Careful  examination  of  the  vertebral  column  may  then 
detect  a  slight  depression  or  irregularity  in  the  direction  of  the 
sjiine,  and  there  may  be  a  diminution  or  loss  of  sensation  in  the 
i:)Osterior  part  of  the  trunk  while  the  anterior  portion  continues  to 
be  as  sensitive  as  before.  In  making  an  attemjit  to  get  upon  his 
feet,  however,  upon  the  removal  of  the  hobbles,  only  the  fore  part 
of  the  body  will  respond  to  the  effort,  a  degree  of  paraplegia  being 
present,  and  while  the  head,  neck,  and  fore  -pea-i  of  the  body  will 
be  raised,  the  hind  quarters  and  hind  legs  will  remain  inert.  The 
animal  may  perhajDS  succeed  in  rising  and  probably  may  be  re- 


FRACTURES.  237 


Fig.  262.— Fracture  of  tho  Axis  in  an  Animal  Suffering  with  Osteo-Porosis. 

moved  to  his  stall,  but  the  displacement  of  the  bone  will  follow, 
converting  the  fracture  into  one  of  the  comj^lete  kind,  either 
through  the  exertion  of  walking  or  by  a  renewed  attempt  to  rise 
after  another  fall,  before  reaching  his  stall.  By  this  time  the 
paralysis  is  comj)lete,  and  the  extension  of  the  meningitis  which 
has  become  estabHshed  is  a  consummation  soon  reached. 

To  say  that  the  prognosis  of  fracture  of  the  body  of  the  vertebrae 
is  always  serious  is  to  speak  very  mildly.  It  were  better,  jjerhaps, 
to  say  that  occasionally  a  case  may  recover.  Fractures  of  the 
transverse  processes  are  less  serious. 

Instead  of  stating  the  indication  in  this  class  of  cases,  as  if 
assuming  them  to  be  medicable,  the  question  naturally  becomes 
rather  a  query :  "  Can  any  treatment  be  recommended  in  a  fractui'e 
of  the  body  of  a  vertebra?"  The  only  indication  in  such  a  case, 
in  our  opinion,  is  to  reach  the  true  diagnosis  in  the  shortest  pos- 
sible time  and  to  act  accordingly.  If  there  is  displacement,  and 
the  existence  of  serious  lesions  may  be  inferred  from  the  nervous 
symptoms,  the  destruction  of  the  suffering  animal  appears  to  sug- 
gest itself  as  the  one  conclusion  in  which  considerations  of  policy, 
humanity,  and  science  at  once  unite. 

If,  however,  it  is  faMy  evident  that  no  disjDlacement  exists; 
that  pressure  upon  the  sj^inal  cord  is  not  yet  present;  that  the 
animal  with  a  little  assistance  is  able  to  rise  upon  his  feet  and  to 
walk  a  short  distance,  it  may  be  weU  to  experiment  upon  the  case 
to  the  extent  of  placing  the  patient  in  the  most  favorable  circum- 
stances for  recovery,  and  allow  nature  to  operate  without  further 
interference.     This  may  be  accomplished  by  securing  immobility 


238  OPERATIONS    ON    BONES. 

of  the  whole  body  as  much  as  j)ossible,  and  especially  of  the  sus- 
pected region,  by  placing  the  patient  in  slings,  in  a  stall  sufficiently 
narrow  to  preclude  lateral  motion,  and  covering  the  loins  with  a 
thick  coat  of  agglutinative  mixtui-e,  and  wait  for  developments. 

Fracture  of  the  Ribs. — The  different  regions  of  the  chest  are 
not  equally  exjDOsed  to  the  violence  to  which  fractm-es  of  the  ribs 
are  due,  and  they  are  therefore  either  more  common  or  more  easily 
discovered  during  life  at  some  points  than  at  others.  The  more 
exposed  regions  are  the  middle  and  the  posterior,  while  the  front 
is  largely  covered  and  defended  by  the  shoulder.  A  single  rib 
may  be  the  seat  of  fracture,  or  a  number  may  be  involved,  and 
there  may  be  injuries  on  both  sides  of  the  chest  at  the  same  time. 
It  may  take  place  lengthwise,  in  any  part  of  the  bone,  though  the 
middle,  being  the  most  exposed,  is  the  most  frequently  hiu-t.  In- 
complete fractures  are  usually  lengthwise,  involving  a  portion  only 
of  the  thickness,  or  one  or  other  of  the  surfaces.  The  complete 
kind  may  be  either  transverse  or  obhque,  and  are  most  commonly 


,  Fig.  263.— United  Transversal  and  Longitudinal  Fractures  of  the  Ribs. 

denticulated.  The  fracture  may  be  comminuted,  and  a  single 
bone  may  show  one  of  the  complete  and  one  of  the  incomplete 
kind  at  different  points.  The  extent  of  sm'face  presented  by  the 
thoracic  region,  with  its  complete  exposure  at  all  points,  explains 
the  liabihty  of  the  ribs  to  suffer  from  all  forms  of  external  vio- 
lence. 

In  many  instances  fractures  of  these  bones  continue  undiscov- 
ered, especially  the  incomplete  variety,  without  displacement, 
though  the  evidences  of  local  pain,  a  certain  amount  of  swelling 
and  a  degree  of  distm-bance  of  the  respiration,  if  noticed  during 
the  examination  of  a  jDatient,  may  suggest  a  suspicion  of  their  ex- 
istence. Abnormal  mobility  and  crepitation  are  difficult  of  de- 
tection, even  when  present,  and  they  are  not  always  present. 


FUACTURES. 


239 


"Wlieu  there  is  tlisplacemeut  tlie  deformity  which  it  occasions  will 
betray  the  fact,  and  when  such  an  injury  exists  the  sm-geon  will, 
of  course,  become  vigilant  in  view  of  jDossible  and  probable  com- 
phcations  of  thoracic  trouble,  and  prepare  himself  for  an  encoun- 
ter with  a  case  of  traumatic  pleuritis  or  pneumonia.  Fatal  injur- 
ies of  the  heart  are  recorded.  Subcutaneous  emphysema  is  a 
common  accompaniment  of  broken  ribs,  and  we  recall  the  death 
from  this  cause  of  a  patient  of  our  ovm,  which  had  suffered  a  frac- 
ture of  two  ribs  in  the  region  of  the  withers  under  the  cartilages 
of  the  shoulder,  and  of  which  the  diagnosis  was  made  only  after 
the  fatal  ending  of  the  case. 

These  hurts  are  not  often  of  a  very  serious  character,  though 
the  union  is  never  as  solid  and  complete  as  in  other  fractures,  the 
callus  being  usually  imperfect  and  of  a  fibrous  character,  with  an 
amphiartkrosis  formation.  Still,  comj)Hcations  occur  which  may 
impart  gravity  to  the  prognosis. 

Fractures  with  but  a  slight  or  no  displacement  need  no  reduc- 
tion. All  that  is  necessary  is  a  simple  application  of  a  blistering 
nature  as  a  preventive  of  inflammation  or  for  its  subjugation  when 
present,  and  in  order  to  excite  an  exudation  which  will  tend  to 
aid  in  the  support  and  immobHization  of  the  parts.  At  times, 
however,  a  better  effect  is  obtained  by  the  application  of  a  band- 
age placed  firmly  around  the  chest,  although,  while  this  limits  the 
motion  of  the  ribs,  it  is  aj)t  to  render  the  respiration  more  labored. 

If  there  is  displacement  with  much  accompanying  pain  and 
evident  irritation  of  the  lungs,  the  fracture  must  be  reduced  with- 
out delay.  The  means  of  effecting  this  vary  according  to  whether 
the  displacement  is  outward  or  inward.  In  the  first  case  the 
bone  may  be  straightened  by  pressure  from  without,  while  in  the 
second  the  end  of  the  bone  mvist  be  raised  by  a  lever,  for  the  in- 
troduction of  which  a  small  incision  through  the  skin  and  inter- 
costal spaces  wiU  be  necessary.  When  coaptation  has  been  af- 
fected it  must  be  retained  by  the  external  apphcation  of  adhesive 
mixture,  with  spUnts  and  bandages  around  the  chest. 

Fractures  of  the  hones  of  the  pelvis  wiU  be  considered  under 
their  separate  denominations,  as  those  of  the  sacrum  and  the  as 
innominata,  or  the  hip,  which  includes  the  subdivision  of  the 
iUum,  the  pubes,  and  the  ischium. 

The  Sacrum. — Fractures  of  this  bone  are  rarely  met  with 
among  solipeds.     Among  cattle,  however,  it  is  of  common  occur- 


240  OPERATIONS   ON   BONES. 

rence,  being  attributed  not  only  to  the  usual  varieties  of  violence, 
as  blows  and  other  external  hurts,  but  to  the  act  of  coition,  and 
to  violent  efforts  in  partm-ition.  It  is  generally  of  the  transverse 
kind,  and  may  be  recognized  by  the  deformity  which  it  occasions. 
This  is  due  to  the  dropi^ing  of  the  bone,  with  a  change  in  its  di- 
rection and  a  lower  attachment  of  the  tail,  which  also  becomes 
more  or  less  paralyzed.  The  natural  and  spontaneous  rehef  which 
usually  interposes  in  these  cases  has  doubtless  been  observed  by 
the  extensive  cattle  breeders  of  the  West,  and  their  j)ractice  and 
example  fully  establishes  the  inutility  of  interference.  Still,  cases 
may  occur  in  which  reduction  may  be  indicated,  and  it  then  be- 
comes a  matter  of  no  difficulty.  It  is  effected  by  the  introduction  of 
a  round,  smooth  piece  of  wood  into  the  rectum  as  far  as  the  frag- 
ment of  the  bone,  and  using  it  as  a  lever,  resting  it  upon  another 
as  a  fulcrum  placed  under  it  outside.  The  bone  having  been  thus 
returned  maybe  kept  in  place  by  the  ordinary  external  means  in  use. 

The  Os  Innominata. — Fractures  of  the  ilium  may  be  observed 
either  at  the  angle  of  the  hip  or  at  the  neck  of  the  bone  ;  those  of 
the  pubes  may  take  place  at  the  s^nnphysis,  or  in  the  body  of  the 
bone ;  those  of  the  ischium  on  the  floor  of  the  bone,  or  at  its  pos- 
terior external  angle.  Or,  again,  the  fracture  may  involve  all 
three  of  these  constituent  parts  of  the  hip  bone  by  ha\'ing  its  situ- 
ation in  the  articular  caAdty — the  acetabulum  by  which  it  joins  the 
femur  or  thigh  bone. 

Some  of  these  fractures  are  easily  recognized,  while  others  are 
difficult  to  identify.  The  ordinary  deformity  which  characterizes 
a  fracture  of  the  external  angle  of  the  ilium,  its  dropping  and  the 
diminution  of  that  side  of  the  hip  in  width,  unite  in  indicating  the 
existence  of  the  condition  expressed  by  the  term  "hipj)ed."  But 
an  incomj)lete  fractiu-e,  or  one  that  is  complete  without  displace- 
ment, or  even  one  with  displacement,  often  demands  the  closest 
scrutiny  for  its  discovery.  The  lameness  may  be  well  marked,  and 
an  animal  may  show  but  little  aj^pearance  of  it  while  walking,  but 
upon  being  urged  into  a  trot  will  manifest  it  more  and  more,  until 
presently  he  will  cease  to  use  the  crippled  limb  altogether,  and 
perform  his  traveling  entirely  on  three  legs.  The  acute  character 
of  the  lameness  will  vai'y  in  degree  as  the  seat  of  the  lesion  ap- 
proximates the  acetabulum.  In  walking,  the  motion  at  the  hip  is 
very  limited,  and  the  leg  is  dragged,  while  at  rest  it  is  relieved 
from  beai-ing  its  share  in  sustaining  the  body.     An  intelligent 


FRACTURES. 


241 


Fig.  264.— Fractures  of  tho  Ossa  Innominata :  1,  at  the  external  angle ;  2,  at  the 
internal  angle;  3,  at  the  neck  of  the  ilium;  4,  at  the  body  of  the  pubis;  4«,  at  the 
antero-esternal  angle  of  the  ischium  ;  5,  at  the  cotyloid  cavity ;  6,  at  the  postero-exter- 
nal  angle  of  the  ischium  ;  7,  at  the  symphysis  pubis. 

opiniou  and  correct  conclusion  will  depend  largely  upon  a  knowl- 
edge of  tlie  history  of  the  case,  and  while  in  some  instances  that 
will  be  but  a  report  of  the  common  etiology  of  fractures,  such  as 
blows,  hurts,  and  other  external  violence,  the  simple  fact  of  a  fall 
may  furnish  a  satisfactory  solution  of  the  whole  matter. 

With  the  exception  of  the  deformity  of  the  ilium  in  a  fractiu'e 
of  its  external  angle,  and  unless  there  has  been  a  serious  laceration 
of  tissues  and  infiltration  of  blood,  or  excessive  displacement,  there 
are  no  very  definite  external  symptoms  in  a  case  of  a  fracture  of 
the  hip  bone.  There  is  one,  however,  which,  in  a  majority  of  cases, 
will  not  fail — it  is  crepitation.  This  evidence  is  attainable  by  both 
external  and  internal  examination — by  manipulation  of  the  gluteal 
surface  and  by  rectal  taxis.  Very  often  a  lateral  motion,  or  bal- 
ancing of  the  hinder  parts  by  pressing  the  body  from  one  side  to 
the  other,  will  be  sufficient  to  render  the  crepitation  more  distinct 
— a  shght  sensation  of  grating,  which  may  be  perceived  even  through 
the  thick  coating  of  muscle  which  covers  the  bone — and  the  sensa- 
tion may  not  only  be  felt,  but  to  the  ear  of  the  expert  may  even 
become  audible.  This  external  manifestation  is,  however,  not 
always  sufficient  in  itself,  and  should  always  be  associated  with  the 
rectal  taxis  for  corroboration.  It  is  true  that  this  may  fail  to  add  to 
the  evidence  of  fracture,  but  till  then  the  simple  testimony  afforded 


242  OPERATIONS    ON    BONES. 

by  the  detection  of  crepitation  from  the  surface,  though  a  strong 
confirmatory  point,  is  scarcely  sufficiently  absolute  to  establish 
more  than  a  reasonable  probability  or  strong  suspicion  in  the  case. 

In  addition  to  the  fact  that  the  rectal  examination  brings  the 
exploring  hand  of  the  surgeon  into  near  proximity  to  the  desii-ed 
point  of  search,  and  to  an  accurate  knowledge  of  the  situation  of 
parts,  both  ^^ro  and  con  as  respects  his  own  views,  there  is  another 
advantage  attendant  upon  it  which  is  well  entitled  to  appreciation. 
This  is  the  facility  wdth  which  he  can  avail  himself  of  the  co-opera- 
tion of  an  assistant,  who  can  aid  him  by  manipulating  the  implicated 
limb  and  placing  it  in  various  positions,  so  far  as  the  patient  will 
permit,  while  the  sm-geon  himself  is  making  explorations  and  study- 
ing the  effect  from  within.  By  this  method  he  can  hardly  fail  to 
ascertain  the  character  of  the  fracture  and  the  condition  of  the 
bony  ends.  By  the  rectal  taxis,  as  if  with  eyes  in  the  finger  ends, 
he  will  "  see  "  what  is  the  extent  of  the  fracture  of  the  ilium  or  of 
the  neck  of  that  bone ;  to  what  part  of  the  central  portion  of  the 
bone  (the  acetabulum)  it  reaches ;  whether  this  is  free  from  disease 
or  not,  and  in  what  location  on  the  floor  of  the  pelvis  the  lesion  is 
situated.  We  have  frequently,  by  this  method,  been  able  to  detect 
a  fracture  at  the  symphysis,  which  from  its  history  and  symptoms 
and  an  external  examination,  could  only  have  been  guessed  at. 

Yet,  with  all  its  advantages,  the  rectal  examination  is  not  always 
necessary,  as,  for  example,  when  the  fracture  is  at  the  posterior 
and  external  angle  of  the  ischium,  when  by  friction  of  the  bony 
ends  the  svurgeon  may  discern  the  crepitation  without  it. 

Every  variety  of  compUcation,  including  muscidar  lacerations 
with  the  formation  of  deep  abscesses  and  injuries  to  the  organs 
of  the  pelric  cavity,  the  bladder,  the  rectum,  and  the  uterus,  may 
be  associated  with  fractures  of  the  hip  bone. 

The  prognosis  of  these  lesions  will  necessarily  vary  considerably. 
A  fracture  of  the  most  superficial  part  of  the  bone  of  the  ilium  or 
of  the  ischium,  especially  where  there  is  httle  displacement,  will 
unite  rapidly,  lea\ang  a  comparatively  sound  animal  often  quite 
free  from  subsequent  lameness.  But  if  there  is  much  displacement, 
only  a  Hgamentous  union  will  take  place,  with  much  deformity  and 
more  or  less  irregularity  in  the  gait.  Other  fractures  may  be  fol- 
lowed by  complete  disability  of  the  patient,  as,  for  example,  when 
the  cotyloid  cavity  is  involved,  or  when  the  reparatory  process  has 
left  bony  deposits  in  the  pelvic  cavity  at  the  seat  of  the  union. 


FKACTUBES.  243 

which  may,  -with  the  female,  interfere  with  the  steps  of  parturition, 
or  induce  some  local  paralysis  by  pressure  upon  the  nerves  which 
govern  the  muscles  of  the  hind  legs.  This  is  a  condition  not  in- 
frequently observed  when  the  callus  has  been  formed  on  the  floor 
of  the  pelvis  near  the  obtm-ator  foramen,  pressing  upon  the  course 
or  involving  the  obturator  nerve. 

The  treatment  of  all  fractm-es  of  the  hij)  bone  should,  in  our 
estimation,  be  of  the  simplest  kind.  Rendered  comparatively  im- 
movable by  the  thickness  of  the  muscles  by  which  the  region  is 
envelojoed,  one  essential  indication  suggests  itself,  and  that  is,  to 
place  the  animal  in  a  position  which,  as  far  as  possible,  will  be  fixed 
and  permanent.  For  the  accomplishment  of  this  purpose  the  best 
measure,  as  we  consider  it,  is  to  place  him  in  a  stall  of  just  suffi- 
cient width  to  admit  him,  and  to  apply  a  set  of  slings  snugly,  but 
comfortably.  This  will  fulfill  the  essential  conditions  of  recovery, 
rest,  and  immobility.  Bhstering  applications  would  be  injurious, 
though  the  adhesive  mixture  might  prove  in  some  degree  beneficial. 

The  minimum  period  allowable  for  solid  union  in  a  fractured 
hija  is,  in  our  judgment,  two  months,  and  we  have  known  cases 
in  which  that  was  too  short  a  time. 

As  we  have  before  said,  there  may  be  cases  in  which  the 
treatment  for  fracture  at  the  floor  of  the  pelvis  has  been  followed 
by  symptoms  of  partial  paralysis,  the  animal,  when  lying  down, 
being  unable  to  regain  his  feet,  but  moving  freely  w^hen  placed  in 
an  upright  position.  This  condition  is  due  to  the  interference  of 
the  callus  with  the  functions  of  the  obturator  nerve,  which  it 
presses  upon  or  surrounds.  "VVe  feel  warranted  by  oui*  experience 
in  similar  cases  in  cautioning  owners  of  horses  in  this  condition 
to  exercise  due  patience,  and  to  avoid  a  premature  sentence  of 
condemnation  against  their  invahd  servants ;  they  are  not  all  irre- 
coverably paralytic.  With  alternations  of  moderate  exercise,  rest  in 
the  slings,  and  the  effect  of  time  while  the  natural  process  of  ab- 
sorption is  taking  effect  upon  the  callus,  with  other  elements  of 
change  that  may  be  so  operating,  the  horse  may  in  due  time  be- 
come able  to  once  more  earn  his  subsistence  and  serve  his  master. 

Fracture  of  the  Scapula. — This  bone  is  seldom  fractiired,  its 
comparative  exemption  being  due  to  its  free  mobihty  and  the  pro- 
tection it  receives  from  the  superimposed  soft  tissues.  Only 
direct  and  powerful  causes  are  sufficient  to  effect  the  injury,  and 
when  it  occurs  the  large  rather  than  the  smaller  animals  are  the 


244 


OPERATIONS    ON    BONES. 


Fig.  265.— Transverse  Fracture  of  the  Scapula. 

subjects.  The  causes  are  heavy  blows  or  kicks,  and  violent 
coUisions  with  iinjaeldiug  objects.  Those  which  are  occasioned 
by  falls  are  generally  at  the  neck  of  the  bone,  and  of  the  trans- 
verse and  comminuted  varieties. 

The  diagnosis  is  not  always  easy.  The  symptoms  are  inabihty 
to  rest  the  leg  on  the  ground  and  to  carry  weights,  and  they  are 
present  in  various  degrees  from  slight  to  severe.  The  leg  rests 
upon  the  toe  and  seems  shortened,  locomotion  is  performed  by 
jumps.  Movuig  the  leg  while  examining  it  and  raising  the  foot 
for  inspection  seem  to  produce  much  pain  and  cause  the  animal 
to  rear.  Crepitation  is  readily  felt  with  the  hand  upon  the 
shoulder  when  the  leg  is  moved.  If  the  fractui-e  occvirs  in  the 
upper  part  of  the  bone,  overlapping  of  the  fragments  and  dis- 
jjlacement  will  be  considerable. 

The  fractm-e  of  this  bone  is  usually  classed  among  the  more 
serious  accidents,  though  cases  may  occui-  which  are  followed  by 
recovery  without  very  serious  ultimate  results,  especially  when 
the  seat  of  the  injury  is  at  some  of  the  upper  angles  of  the  bone, 
or  about  the  acromion  crest.     But  if  the  neck  and  the  joint  are 


FRACTURES. 


245 


Fig.  266.— Bourgelat  Apparatus  for  Fracture  and  Dislocation  of  the  Shoulder  Joint. 


Fig.  267.— The  same  in  place. 


246 


OPEKATIONS    ON    BONES. 


the  parts  involved,  complications  are  apt  to  be  present  which  are 
likely  to  disable  the  animal  for  life. 

If  there  is  no  displacement  a  simple  adhesive  dressing,  to 
strengthen  and  immobilize  the  parts,  will  be  sufficient.  A  coat  of 
black  pitch  dissolved  with  wax  and  Venice  turpentine,  kept  in  place 
over  the  region  with  oakum  or  hnen  bands,  will  be  all  the  treat- 
ment required,  especially  if  the  animal  is  kept  quiet  in  the  shngs. 

Displacement  cannot  be  remedied,  and  reduction  is  next  to 
impossible.  Sometimes  an  iron  plate  is  applied  over  the  parts 
and  retained  by  bandages,  as  in  the  dressing  of  Bourgelat  (Figs. 
266,  267) ;  and  this  may  be  advantageously  replaced  by  a  pad  of 
thick  leather.  In  smaller  animals,  and  also  in  larger  ones,  the 
parts  are  retained  by  figure-8  bandages,  embracing  both  the  nor- 
mal and  the  diseased  shoulders,  crossing  each  other  in  the  axilla 
and  covered  with  a  coating  of  adhesive  mixture. 


Fig.  268.— Delwart's  Bandage  for 
Fracture  of  the  Scapula. 


Fig.  269.— Anotlier  Bandage, 
with  Iron  Splints. 


Fractures  of  the  Humerus. — These  are  more  common  in  small 
than  in  large  animals,  and  are  always  the  result  of  external  trau- 
matism. They  are  generally  very  oblique,  are  often  comminuted, 
and  though  more  usually  involving  the  shaft  of  the  bone  will  in 
some  cases  extend  to  the  upper  end  and  into  the  articular  head. 
There  is  ordinarily  considerable  displacement  in  consequence  of 


FKACTURES. 


2i' 


the  overlapping  of  the  broken  ends  of  the  bone,  and  this,  of 
course,  causes  more  or  less  shortening  of  the  limb.  There  will 
also  be  swelling,  with  difficulty  of  locomotion,  and  crepitation  will 
be  easy  of  detection.  This  fracture  is  always  a  serious  damage 
to  the  patient,  leaving  him  with  a  permanently  shortened  limb 
and  a  remediless,  lifelong  lameness. 

If  treatment  is  determined  upon,  it  will  consist  in  the  reduction 
of  the  fracture  by  means  of  extension  and  counter  extension,  and 
in  order  to  accomphsh  this  the  animal  must  be  thrown.  If  suc- 
cessful in  the  reduction,  then  follows  the  application  and  adjust- 


Pig.  270  — Comminutd  Frac- 
ture of  theHumeruB. 


Fig.  271.— Oblique  Fracture  of  the  Humerus 
with  Displacement  and  Partial  I'udji 


ment  of  the  apparatus  of  retention,  which  must  needs  be  of  the 
most  perfect  and  efficient  kind.  And  finally,  this,  however  skill- 
fully contrived  and  carefully  adapted,  will  often  fail  to  effect  any 
good  purpose  whatever. 

Fracture  of  the  Forearm. — A  fracture  in  this  region  may  also 
involve  the  radius  or  the  cubitus,  the  first  being  broken  at  times 
in  its  upper  portion  above  the  radio-cubital  arch  at  the  olecranon. 
If  the  fracture  occurs  at  any  part  of  the  forearm  from  the  radio- 


248 


OPEKATIONS    ON    BONES. 


cubital  arch  down  to  the  knee,  it  may  involve  either  the  radius 
alone  or  the  radius  and  the  cubitus,  which  there  intimately  unite. 
Besides  having  the  same  etiology  with  most  of  the  fractures, 
those  of  the  forearm  are,  nevertheless,  more  commonly  due  to 
kicks  from  other  animals,  especially  when  crowded  together  in 
large  numbers  in  insufficient  space.  It  is  a  matter  of  observation 
that,  under  these  circumstances,  fractures  of  the  incomplete  kind 


Fig.  271a.— Consolidatea  Frac- 
of  the  Body  of  the  Humerus. 


Fig.  272. 
Fractures  of  the  Radius. 


are  those  which  occur  on  the  inside  of  the  leg,  the  bone  being  in 
that  region  almost  entirely  subcutaneous,  while  those  of  the  com- 
plete class  are  either  oblique  or  transverse.  The  least  common 
are  the  longitudinal,  in  the  long  axis  of  the  bone. 

This  variety  of  fracture  is  easily  recognized  by  the  appearance 
of  the  leg  and  the  different  changes  it  undergoes.  There  is 
inabiUty  to  use  the  limb;  impossibility  of  locomotion;  mobility 


FRACTURES.  249 


Fig.  273.— Fracture  of  the  Ulna. 

below  the  injury ;  the  ready  detection  of  crepitation — in  a  word, 
the  assemblage  of  aU  the  signs  and  symptoms  which  have  been 
already  considered  as  associated  with  the  history  of  broken  bones. 

The  fracture  of  the  cubitus  alone,  principally  above  the  radio- 
cubital  arch,  may  be  ascertained  by  the  aggravated  lameness,  the 
excessive  soreness  on  pressure,  and  perhaps  a  certain  increase  of 
motion,  with  a  very  slight  crepitation  if  tested  for  in  the  usual 
way.'  Displacement  is  not  likely  to  take  place  except  when  it  is 
well  up  towards  the  olecranon  or  its  tuberosity,  the  upper  seg- 
ment of  the  bone  being  in  that  case  likely  to  be  drawn  upward. 
For  a  simple  fracture  of  this  region  there  exists  a  fair  chance  of 
recovery,  but  in  a  case  of  the  compound  and  comminuted  class 
there  is  less  ground  for  a  favorable  prognosis,  especially  if  the 
elbow  joiat  has  suffered  injury.  A  fracture  of  the  cubitus  alone 
is  not  of  serious  importance,  except  when  the  same  conditions 
prevail.  A  fracture  of  the  olecranon  is  less  amenable  to  treat- 
ment, and  promises  little  better  than  a  Ugamentous  union. 

Considering  all  the  various  conditions  involving  the  nature  and 
extent  of  these  lesions,  the  position  and  direction  of  the  bones 
of  the  forearm  are  such  as  to  render  the  chances  for  recovery  from 
fracture  as  among  the  best.     The  reduction,  by  extension  and 


250 


OPERATIONS    ON    BONEo, 


counter-extension ;  the  maintenance  of  the  coaptation  of  the  seg- 
ments; the  adai^tation  of  the  dressing  by  sphnts,  oakum,  and 
agglutinative  mixtures;  in  a  word,  all  the  details  of  treatment  may 
be  here  fulfilled  with  a  degree  of  facility  and  precision  not  attain- 
able in  any  other  part  of  the  organism.  An  important  if  not  an 
essential  j^oint,  however,  must  be  emphasized  in  regard  to  the 
splints.  "Whether  these  are  of  metal,  wood,  or  other  material,  they 
should  reach  from  the  elbow  joint  to  the  ground,  and  should  be 
placed  on  the  posterior  face  and  on  both  sides  of  the  leg.  This  is 
then  to  be  so  confined  in  a  properly  construct- 
ed box  as  to  preclude  all  possibility  of  motion, 
while  yet  it  must  sustain  a  certain  portion  of 
the  weight  of  the  body.  The  iron  splint  rec- 
ommended by  Bourgelat  is  designed  for  frac- 
tures of  the  forearm,  of  the  knee,  and  of  the 
cannon  bone,  and  will  prove  to  be  an  appliance 
of  great  value.  For  small  animals  our  prefer- 
ence is  for  an  external  covering  of  gutta  per- 
cha,  embracing  the  entire  leg.  A  sheet  of  this 
substance  of  suitable  thickness,  according  to 
the  size  of  the  animal,  softened  in  lukewarm 
water,  is,  when  sufficiently  pliable,  molded  on 
the  outside  of  the  leg,  and  when  suddenly 
hardened  by  the  application  of  cold  water 
forms  a  complete  casing  sxifficiently  rigid  to 
resist  all  motion.  Patients  treated  in  this 
manner  have  been  able  to  use  the  limb  freely, 
without  pain,  immediately  after  the  application 
of  the  dressing.  The  removal  of  the  splint  is 
easily  effected  by  cutting  it  away,  either  wholly 
or  in  sections,  after  softening  it  by  immersing  the  leg  in  a  warm 
bath. 

Fracture  of  the  Knee — This  accident,  haj^pily,  is  of  rare  occur- 
rence, but  when  it  takes  place  is  of  a  severe  character,  being  of  the 
comminuted  kind,  and  always  accompanied  by  syno\'itis,  with  dis- 
ease of  the  joint,  requiring  for  treatment  therefor,  besides  the  in- 
dication of  perfect  immobility  of  the  joint,  that  of  open  joints, 
synovitis,  and  arthritis. 

Fracture  of  the  Femur. — The  protection  which  this  bone  re- 
ceives from  the  large  mass  of  muscles  in  which  it  is  enveloped  does 


Fig.  274.  —  Bourgelat'8 
Iron  Splint  for  Fracture 
and  Lugation  of  the 
Forearm. 


FRACTURES. 


251 


not  suffice  to  invest  it  with  immunity  in  regard  to  fractures.  It 
contributes  its  shai'e  to  the  list  of  accidents  of  this  description, 
sometimes  in  consequence  of  external  violence  and  sometimes  as 
the  result  of  muscular  contraction ;  sometimes  it  takes  place  at 
the  upper  extremity  of  the  bone;  sometimes  at  the  lower;  some- 
times at  the  head,  when  the  condyles  become  implicated ;  but  it  is 
principally  found  in  the  body  or  diaphysis.  The  fracture  may  be 
of  any  of  the  ordinary  forms,  simple  or  compound,  complete  or  in- 
complete, transverse  or  oblique,  etc.  A  case  of  the  comminuted 
\  ariety  is  recorded  in  which  eighty-five  fragments  of  bone  were 
counted  and  removed. 

The  thickness  of  the  muscular  covering  sometimes  renders  the 
diagnosis  difficult  by  interfering  with  the  manipulation,  but  the 
crepitation  test  is  readily  available  even  when  the  swelling  is  con- 
siderable and  which  is  likely  to  be  the  case  as  the  result  of  the  in- 


FiG.  276.— Fracture,  with  Shortening. 


252  OPERATIONS   ON   BONES. 

terstitial  bemorrhagt^  which  naturally  follows  the  laceration  of  the 
blood  vessels  of  the  region  involved.  If  the  fracture  is  at  the  neck 
of  the  bone  the  muscles  of  that  region  (the  gluteal)  are  firmly  con- 
tracted and  the  leg  seems  to  be  shortened  in  consequence.  Loco- 
motion is  impossible.  Crepitation  may  in  some  cases  be  discerned 
by  rectal  examination,  with  one  hand  resting  over  the  coxo  femoral 
articulation.  Fractures  of  the  tuberosities  of  the  upper  end  of 
the  bone,  the  great  trochanter,  may  be  identihed  by  the  deform- 
ity, the  swelling,  the  impossibility  of  rotation,  and  the  dragging 
of  the  leg  in  walking.-  Fractui-e  of  the  body  is  always  accompanied 
by  displacement,  and  as  a  consequence  a  shortening  of  the  leg, 
which  is  carried  forward.  The  lameness  is  excessive,  the  foot 
being  moved,  both  when  raising  it  from  the  ground  and  when 
setting  it  down,  very  timidly  and  cautiously.  The  manipulations 
for  the  discovery  of  crepitation  always  cause  much  pain.  Lesions 
of  the  lower  end  of  the  bone  are  more  difficult  to  diagnosticate 
with  certainty,  though  the  manifestation  of  pain  while  making 
heavy  pressure  upon  the  condyles  will  be  so  marked  that  only 
crepitation  will  be  needed  to  turn  a  suspicion  into  a  certainty. 

The  question  as  to  treatment  in  fractures  of  this  description 
resolves  itself  into  the  query  whether  any  treatment  can  be  sug- 
gested that  can  avail  anything  practically  as  a  curative  measure, 
whether,  upon  the  hypothesis  of  reduction  as  an  accomplished  fact, 
any  permanent  or  efficient  device  as  a  means  of  retention  is  within 
the  scope  of  human  ingenuity.  If  the  reduction  were  successfully 
performed  would  it  be  possible  to  keep  the  parts  in  place  by  any 
known  means  at  our  disposal?  At  the  best  the  most  favorable 
resvdt  that  could  be  anticipated  would  be  a  reunion  of  the  fragments, 
with  a  considerable  shortening  of  the  bone,  and  a  helpless,  limp- 
ing, crippled  animal  to  remind  us  that  for  human  achievement 
there  is  a  "thus  far,  and  no  farther." 

In  small  animals,  however,  attempts  at  treatment  are  justifiable, 
and  we  are  convinced  that  in  many  cases  of  difficulty  in  the  appli- 
cation of  si^lints  and  bandages  a  patient  may  be  placed  in  a  con- 
dition of  undisturbed  quiet  and  left  to  the  processes  of  nature  for 
"treatment"  as  safely  and  with  as  good  an  assurance  of  a  favorable 
result  as  if  he  had  been  subjected  to  the  most  heroic  secundurn 
artem  doctoring  known  to  science.  As  a  case  in  point,  we  may 
mention  the  case  of  a  pregnant  bitch  which  suffered  a  fracture  of 
the  upper  end  of  the  femur  by  being  run  over  by  a  light  wagon. 


FRACTURES.  253 

Her  "treatment''  consisted  in  being  tied  up  in  a  large  box  and 
let  alone.  In  due  time  she  was  delivered  of  a  family  of  puppies, 
and  in  three  weeks  she  was  running  in  the  streets,  limping  very 
sUghtly,  and  nothing  the  worse  for  her  accident. 

Fracture  of  the  Patella. — This,  fortunately,  is  a  rare  accident 
and  can  only  result  from  direct  violence,  as  a  kick  or  other  blow. 
The  lameness  which  follows  it  is  accompanied  with  enormovis 
tumefaction  of  the  joint  and  disease  of  the  articulation.  The  prog- 
nosis is  unavoidably  adverse,  destruction  being  the  only  termi- 
nation of  an  incurable  and  very  painful  injury. 

Fractures  of  the  Tibia  are  probably  more  frequently  encoun- 
tered than  any  others  among  the  class  of  accidents  we  are  consid- 
ering. As  with  injuries  of  the  forearm  of  a  like  character,  they 
may  be  complete  or  incomplete;  the  former  when  the  bone  is 
broken  in  the  middle  or  at  the  extremities,  and  transverse,  oblique, 
or  longitudinal.  The  incomplete  kind  are  more  common  in  this 
bone  than  in  any  other. 

Complete  fractures  are  easy  to  recognize,  either  with  or  without 
displacement.  The  animal  is  very  lame,  and  the  leg  is  either 
dragged  or  held  up  clear  from  the  ground  by  flexion  at  the  stifle, 
while  the  lower  part  hangs  down.  Carrying  weight  or  moving 
backward  is  imi^ossible.  There  is  excessive  mobility  below  the 
fracture  and  well-marked  crepitation.  If  there  is  much  displace- 
ment, as  in  an  oblique  fracture,  there  will  be  considerable  short- 
ening of  the  leg. 

While  incomplete  fractures  cannot  be  recognized  in  the  tibia 
with  any  greater  degree  of  certainty  than  in  any  other  bone,  there 
are  some  facts  associated  with  them  by  which  a  diagnosis  may  be 
justified.  The  hypothetical  history  of  a  case  may  serve  as  an 
illustration : 

An  animal  has  received  an  injuiy  by  a  blow  or  a  kick  on  the 
inside  of  the  bone,  perhaps  without  showing  any  mark.  Becoming 
very  lame  immediately  afterwards,  he  is  allowed  a  few  days'  rest. 
Being  then  taken  out  again,  he  seems  to  have  recovered  his  sound- 
ness, but  within  a  day  or  two,  or  even  in  a  shorter  time,  he  be- 
trays a  little  soreness,  and  this  increasing  he  becomes  very  lame 
again,  to  be  furloughed  once  more,  with  the  result  of  a  temporary 
improvement,  and  again  a  return  to  labor  and  again  a  relapse  of 
the  lameness ;  and  this  alternation  seems  to  be  the  rule.  The  leg 
being  now  carefully  examined,  a  local  periostitis  is  readily  discov- 


254 


OPERATIONS    ON    BONES. 


Fig.  277.— Fracture  of  the 
Tibia. 


Fig.  278.— Bourgelat'B  Irou  Splint  for 
Fractured  Tibia. 


ered  at  the  point  of  the  injury,  the  part  being  warm,  swollen,  and 
painful.  What  further  proof  is  necessary  ?  Is  it  not  evident  that 
a  fracture  has  occurred,  first  superficial — a  mere  split  in  the  bony 
structure  which,  fortunately,  has  been  discovered  before  some 
extra  exertion  or  a  casual  misstep  had  developed  it  into  one  of  the 
complete  kind,  possibly  with  complications?  "What  other  infer- 
ence can  such  a  series  of  symptoms  thus  repeated  establish? 

The  prognosis  of  fracture  of  the  tibia  must,  as  a  rule,  be  un- 
favorable. The  difficulty  of  obtaining  a  union  without  shortening 
and  consequently  without  lameness,  is  proof  of  the  futility  of  or- 
dinary attempts  at  treatment.  But  though  this  may  be  true  in 
respect  to  fractures  of  the  complete  kind,  it  is  not  necessarily  so 
with  the  incomplete  variety,  and  with  this  class  the  simple  treat- 
ment of  the  slings  is  all  that  is  necessary  to  secure  consolidation. 
A  few  weeks  of  this  confinement  wiU  be  sufficient. 

With  dogs  and  other  small  animals,  there  are  cases  which  may 
be  successfully  treated.  If  the  necessary  dressings  can  be  success- 
fully appHed  and  retained,  a  recovery  will  follow. 


FRACTUKES. 


255 


Fractures  of  the  Hock. — Injuries  of  the  astragalus  have  been 
recorded  which  had  a  fatal  termination.  Fractures  of  the  os  calcis 
have  also  been  observed,  but  never  with  a  favorable  prognosis,  and 
attempts  to  induce  recovery  have,  as  might  have  been  anticipated, 
proved  futile. 

Fractures  of  the  Cannon  Bones. — "Whether  these  occur  in  the 
fore  or  hind  legs  they  appear  either  in  the  body  or  near  their  ex- 
tremities. If  in  the  body,  as  a  rule  the  three  metacarpal  or  meta- 
tarsal are  also  affected,  and  the  fracture  is  generally  transverse 
and  oblique,  and  often  compound,  one  of  the  segments  protruding 
sharply  through  the  skin.  Having  only  the  skin  for  a  covering  the 
diagnosis  is  easy.     There  is  no  displacement,  but  excessive  mo- 


f'lQ.  279.— Splint  and  Dressing  for  Fractured  Cannon  i3one. 


256 


OPERATIONS    ON    BONES. 


bility,  crej)itation,  inability  to  sustain  weight,  and  the  leg  is  kept 
off  the  ground  by  the  flexion  of  the  upper  joint. 

No  region  of  the  body  affords  better  facilities  for  the  application 
of  treatment,  and  the  prognosis  is,  on  this  account,  usually  favor- 
able. We  recall  a  case,  however,  which  proved  fatal,  though  under 
exceptional  circumstances.  The  patient  was  a  valuable  staUion  of 
highly  nervous  organization,  with  a  com]30und  fracture  of  one  of 
the  cannon  bones,  and  his  unconquerable  resistance  to  treatment, 
excited  by  the  intense  j)ain  of  the  wound,  precluded  aU  chance  of 
recovery,  and  ultimately  caused  his  death  from  nervous  fever. 

The  general  form  of  treatment  for  these  lesions  will  not  differ 
from  that  which  has  been  already  indicated  for  other  fractures. 
Eeduction,  sometimes  necessitating  the  casting  of  the  patient; 
coaptation,  comparatively  easy  by  reason  of  the  subcutaneous  sit- 
uation of  the  bone ;  retention,  by  means  of  splints  and  bandages 
— appHed  on  both  sides  of  the  region,  and  reaching  to  the  ground 
as  in  fractures  of  the  forearm — these  are  always  indicated.  We 
have  obtained  excellent  results  by  the  use  of  a  mold  of  thicF  gutta 
percha,  composed  of  two  sections  and  made  to  surround  the  entire 
lo.ver  part  of  the  leg  as  in  an  inflexible  case. 

Fracture  of  the  first  Phalanx. — The  hinder  extremity  is  more 
liable  than  the  fore  to  this  injury.     It  is  usually  the  result  of  a 


Fig.  280— Splint  and  Dressing 
on  Lower  Part  of  Fore  Leg. 


Fig.  281.— Bourgelat's  Splint  for  Frac- 
ture of  the  Cannon  and  Phalanges. 


FRACTURES. 


257 


'^'^^'^^iJSli.i^ 


Fig.  28-,' 

Longifudinal  Fractures  of 

the  09  Suffraginis. 


Fig.  5i83. 

Comminuted  Fracture  of  the 

Oa  Suffraginis. 


violent  effort,  or  of  a  sudden  misstep  or  twisting  of  the  leg,  and 
may  be  transverse,  or,  as  has  usually  been  the  case  in  our  experi- 
ence, longitudinal  (Fig.  282),  extending  from  the  upper  articular 
surface  down  to  the  centre  of  the  bone  and  generally  obHque  and 
often  comminuted  (Fig.  283).  The  symptoms  are  the  swelling 
and  tenderness  of  the  region,  possibly  crepitation ;  a  certain  ab- 
normal mobility;  an  excessive  degree  of  lameness,  and  in  some 
instances  a  dropping  back  of  the  fetlock,  with  perhaps  a  straight- 
ened or  upright  condition  of  the  pastern. 

The  difficulty  of  reduction  and  coaptation  in  this  accident,  and 
the  probability  of  bony  deposits,  as  of  ringbones,  resulting  in 
lameness,  are  circumstances  which  tend  to  discourage  a  favorable 
prognosis. 

The  treatment  is  that  which  has  been  recommended  for  all 
fractures,  as  far  as  it  can  be  applied.  The  iron  splint  of  figure 
281  gives  excellent  residts  in  many  instances,  but  if  the  fracture  is 
incomplete  and  without  displacement  a  form  of  treatment  less 
energetic  and  severe  shoiild  be  attempted.  One  case  is  within 
our  knowledge  in  which  the  owner  of  an  injured  horse  lost  his 
property  by  his  refusal  to  subject  the  animal  to  treatment,  the 
post  mortem  revealing  only  a  simple  fracture  with  very  slight  dis- 
placement. 


258 


OFtkATlONS    ON   hO'S'siS. 


Fractures  of  the  Coronet. — Though  these  are  generally  of  the 
commmuted  kind,  there  are  often  conditions  associated  with 
them  which  justify  the  surgeon  in  attempting  their  treatment. 
Though  crej)itation  is  not  alwaj's  easy  to  detect,  the  excessive 
lameness,  the  soreness  on  pressure,  the  inability  to  carry  weight, 
the  difficulty  experienced  in  raising  the  foot,  all  these  suggest,  as 
the  solution  of  the  question  of  diagnosis,  the  fracture  of  the 
coronet,  with  the  accompanying  realization  of  the  fact  that  there 
is  yet,  by  reason  of  the  situation  of  the  member,  immobilized  as  it 
is  by  its  structure  and  its  surroundings,  room  left  for  a  not  un- 
favorable prognosis.  Only  a  sHght  manipulation  will  be  needed 
in  the  treatment  of  this  lesion.     To  render  the  immobihty  of  the 


Fig.  284.— Animal  with  Fracture  below  the  knee  with  Spints  ind  Support, 
Resting  in  Slings. 


FRACTURES.  259 

region  more  fixed,  to  support  the  bones  in  tlieir  position  by  band- 
aging, and  to  establish  forced  immobility  of  the  entire  body 
with  the  slings  is  usually  all  that  is  required.  Ringbone,  being 
a  common  sequela  of  the  reparative  process,  must  receive  due  at- 
tention subsequently.  One  of  the  severest  complications  likely  to 
be  encountered  is  anchylosis. 

Fractures  of  the  Os  2)edls. — Though  these  lesions  are  not  of 
very  rare  occurrence  their  recognition  is  not  easy,  and  there  is 
more  of  speculation  than  of  certainty  pertaining  to  their  diagnosis. 
The  animal  is  very  lame,  and,  as  much  as  possible,  spares  the  in- 
jured foot,  sometimes  resting  it  upon  the  toe  alone  and  sometimes 
not  at  all.  The  foot  is  very  tender,  and  the  exploring  pincers  of 
the  examining  surgeon  causes  much  pain.  There  is  nothing  to 
encourage  a  favorable  prognosis,  and  a  not  unusual  termination 
is  an  anchylosis  with  either  the  navicular  bone  or  the  coronet. 

No  method  of  treatment  needs  to  be  suggested  here,  the  hoof 
performing  the  office  of  retention  unaided.  Local  treatment  by 
baths  and  fomentations  will  do  the  rest.  It  may  be  months 
before  there  is  any  mitigation  of  the  lameness. 

Fracture  of  the  Sesamoid  Hones. — This  lesion  has  been  con- 
sidered by  veterinarians,  erroneously,  we  think,  one  of  rare  oc- 
currence. We  believe  it  to  be  more  frequent  than  has  been  sup- 
posed. Many  observations  and  careful  dissections  have  convinced 
us  that  fractures  of  these  little  bones  have  often  been  mistaken 
for  specific  lesions  of  the  numerous  ligaments  that  are  implanted 
upon  their  superior  and  inferior  parts,  and  which  have  been  de- 
scribed as  a  "giving  way"  or  '-breaking  down"  of  these  liga- 
ments. In  our  post  mortem  examinations  we  have  always  noted 
the  fact  that  when  the  attachments  of  the  ligaments  were  torn 
from  their  bony  connections  minute  fragments  of  bony  structure 
were  also  separated,  though  we  have  failed  to  detect  any  diseased 
process  of  the  fibrous  tissue  comj^osing  the  ligamentous  substance 

From  whatever  cause  this  lesion  may  arise,  it  can  hardly  be 
considered  as  of  a  traumatic  nature,  no  external  violence  having 
any  apparent  agency  in  j)roduciag  it,  and  it  is  our  belief  that  it  is 
due  to  a  pecuhar  degeneration  or  softening  of  the  bones  them- 
selves, a  theory  which  acquires  plausibility  from  the  consideration 
of  the  spongy  consistency  of  the  sesamoids.  The  disease  is  a 
peculiar  one,  and  the  suddenness  with  which  difierent  feet  are 
successively  attacked,  at  short  intervals  and  without  any  obvious 


260  OPERATIONS    ON    BONES. 

cause,  seems  to  prove  the  existence  of  some  latent  morbid  cause 
wiiich  lias  been  unsuspectedly  incubating.  It  is  not  peculiar  to 
any  particular  class  of  horses,  nor  to  any  special  season  of  the 
year,  having  fallen  under  our  observation  ia  each  of  the  four 
seasons.  The  general  fact  is  reported  in  the  history  of  a  majority 
of  cases  that  it  makes  its  appearance  without  premonition  in 
animals  which,  after  enjoying  a  considerable  period  of  rest,  are 
first  exercised  or  put  to  work,  though  in  point  of  fact  it  may 
manifest  itself  while  the  horse  is  still  idle  in  his  stable.  A 
hypothetical  case,  in  illustration,  will  explain  our  theory. 

An  animal  which  has  been  at  rest  in  his  stable  is  taken  out  to 
work  and  it  will  be  presently  noticed  that  there  is  something  un- 


Fig.  285.— Fracturo  of  Os  Sesamoids. 

usual  in  his  movement.  His  gait  is  changed,  and  he  travels  with 
short,  mincing  steps,  without  any  of  his  accustomed  ease  and  free- 
dom. This  may  continue  imtil  his  return  to  the  stable,  and  then, 
after  being  placed  in  his  stall,  he  wUl  be  noticed  shifting  his 
weight  from  side  to  side  and  from  one  leg  to  another,  continuing 
the  movement  until  rupture  of  the  bony  structure  takes  place. 
But  it  may  happen  that  the  lameness  in  one  or  more  of  the  ex- 
tremities, anterior  or  posterior,  suddenly  increases,  and  it  be- 
comes evident  that  the  ruptur^^^  has  taken  place  in  consequence  of 
a  misstep  or  a  stumble  while  the  horse  was  at  work.  Then,  upon 
coming  to  a  standstill,  he  will  be  found  with  one  or  more  of  his 


FRACTURES.  261 

toes  turned  up — he  is  unable  to  place  the  affected  foot  flat  on  the 
ground.  The  fetlock  has  dropped  and  the  leg  rests  upon  this 
part,  the  skin  of  which  may  have  remained  intact  or  may  have 
been  more  or  less  extensively  lacerated.  It  seldom  happens  that 
more  than  one  toe  at  a  time  will  turn  up,  yet  still  the  lesion  in  one 
will  be  followed  by  its  occurrence  in  another.  Commonly  two 
feet  of  a  biped,  the  anterior  or  posterior,  are  affected,  and  we  re- 
call one  case  in  which  the  two  fore  and  one  of  the  hind  legs  were 
included  at  the  same  time.  The  accident,  however,  is  quite  as 
likely  to  happen  while  the  horse  is  at  rest  in  his  stall,  and  he  may 
be  found  in  the  moiTiing  standing  on  his  fetlocks.  One  of  the 
earhest  of  the  cases  occurring  in  our  own  experience  had  been 
under  our  care  for  several  weeks  for  suspected  disease  of  the  fet- 
locks, the  nature  of  which  had  not  been  made  out,  when,  appar- 
ently improved  by  the  treatment  which  he  had  undergone,  the 
patient  was  taken  out  of  the  stable  to  be  walked  a  short  distance 
into  the  country,  but  had  httle  more  than  started  when  he  was 
called  to  a  halt  by  the  fracture  of  the  sesamoids  of  both  fore  legs. 

While  there  are  no  positive  premonitory  symptoms  known  of 
these  fractures  we  believe  that  there  are  signs  and  symptoms 
which  come  but  Httle  short  of  being  so,  and  the  appearance  of 
which  will  always  justify  a  strong  suspicion  of  the  truth  of  the 
case.  These  have  been  indicated  when  referring  to  the  soreness 
in  standing,  the  short  "mincing"  gait,  and  the  tenderness  be- 
trayed when  pressure  is  made  over  the  sesamoids  on  the  sides  of 
the  fetlock,  with  others  less  tangible  and  definable. 

These  injuries  can  never  be  accounted  less  than  serious,  and 
in  our  judgment  will  never  be  other  than  fatal.  If  our  theory  of 
their  pathology  is  the  correct  one,  and  the  cause  of  the  lesions  is 
truly  the  softening  of  the  sesamoidal  bony  structure  and  inde- 
pendent of  any  changes  in  the  ligamentous  fibers,  the  possibihty 
of  a  soHd  osseous  union  can  hardly  be  considered  admissible. 

In  respect  to  the  treatment  to  be  recommended  and  instituted 
it  can  only  be  employed  with  any  rational  hope  of  benefit  during 
the  incubation,  and  with  the  anticipatory  purpose  of  prevention. 
It  must  be  suggested  by  a  suspicion  of  the  verities  of  the  case, 
and  appUed  before  any  rupture  has  taken  place.  To  prevent  this 
and  to  antagonize  the  causes  which  might  precipitate  the  final 
catastrophe — the  elevation  of  the  toes — resort  must  be  had  to  the 
slings  and  to  the  application  of  firm  bandages  or  splints,  perhaps 


262  OPERATIONS    OX    BONES. 

of  plaster  ot  Paris,  with  a  high  shoe,  as  about  the  only  indications 
which  science  and  nature  are  able  to  offer.  When  the  fracture  is 
an  occurred  event,  and  the  toes,  one  or  more,  are  turned  up,  any 
further  resort  to  treatment  will  be  futile. 

DISLOCATIONS. 

Strength  and  soUdity  are  so  combined  in  the  formation  ot  the 
joints  of  our  large  animals  that  dislocations  or  luxations  are  inju- 
ries which  are  but  rarely  encountered.  They  are  met  with  but 
seldom  in  cattle  and  less  so  in  horses,  while  dogs  and  smaller 
animals  are  more  often  the  sufferers. 

The  accident  of  a  luxation  or  (its  synonym)  dislocation  (dis- 
phxcemenf)  is  less  often  encountered  in  the  animal  races  than 
in  man.  This  is  not  because  the  former  are  less  subject  to  oc- 
casional violence  involving  powerful  muscular  contractions,  or  are 
less  often  exposed  to  casualties  similar  to  those  which  result  in 
luxations  in  the  human  skeleton,  but  because  it  requires  the  co- 
operation of  conditions,  anatomical,  physiological,  and  perhaj)S 
mechanical,  present  in  one  of  the  races  and  lacking  in  the  other, 
but  which  can  not  in  every  case  be  clearly  defined.  Perhaps  the 
greater  relative  length  of  the  bony  levers  in  the  human  formation 
may  constitute  a  cause  of  the  difference. 

Among  the  predisposing  causes  in  animals,  caries  of  articular 
surfaces,  articular  abscesses,  excessive  dropsical  conditions,  de- 
generative softening  of  the  ligaments,  and  any  excessive  laxity  of 
the  soft  structures,  may  be  enumerated. 

The  symptoms  of  fractures  and  of  dislocations  are  not  always 
so  variant  as  to  preclude  the  possibility  of  error  in  determining  a 
case  without  a  thorough  examination,  but  the  essential  difference, 
as  it  must  always  exist,  must  always  be  discoverable. 

In  a  dislocation  there  is  one  very  peculiar  and  characteristic 
feature  in  the  impossibility  of  motion  associated  with  an  excessive 
liberty  of  movement — the  impossibility  of  active  or  controlled 
motion,  and  a  facility  of  passive  movement  (or  movableness)  at 
either  the  affected  joint  or  at  another  of  the  same  leg  near  to  it. 
In  a  dislocation  of  the  scapulo-humeral  (or  shoulder)  joint  the 
animal  possesses  no  power  of  motion  over  the  limb — no  muscular 
contraction  can  avail  to  cause  it  to  perform  its  various  functions 
— but  in  the  hands  of  the  surgeon  it  may  be  made  to  describe  a 


DISLOCATIONS.  263 

series  of  movements  which  would  be  sim^j/r  'JiposriiiDle  with  the 
joint  in  a  state  of  integrity.  Both  fractnr(-s  and  luxations  are 
marked  by  deformity,  but  while  in  a  fracture  with  displacement 
there  vrill  usually  be  a  shortening  of  tha  leg,  a  dislocation  may  be 
accompanied  by  either  a  shortening  or  a  lengthening.  Swelling 
of  the  parts  is  usually  a  well-defined  feature  of  these  injuries. 

With  all  this  similarity  in  the  symptomatology  of  luxations 
and  fractures,  there  is  one  sign  which  either  by  its  presence  or  its 
absence  will  greatly  assist  in  settling  a  case  of  differential  diag- 
nosis, and  this  is  the  existence  or  lack  of  cre^y'itation.  It  has  no 
place  or  cause  in  a  mere  dislocation ;  it  belongs  to  a  fracture,  if  it 
is  a  complete  one.  If  there  is  crej)itation  with  a  dislocation  then 
it  proves  that  there  is  a  fract:u.re  also. 

The  prognosis  of  a  luxation  is  comparatively  less  serious  than 
that  of  a  fracture,  though  at  times  the  indications  of  treatment 
may  prove  to  be  so  difficult  to  apply  that  compUcations  may  arise 
of  a  very  severe  character. 

The  treatment  of  luxations  must  of  course  be  similar  to  that 
of  fractures.  Reduction,  naturally,  will  be  the  first  indication  in 
both  cases,  and  the  retention  of  the  replaced  parts  must  follow. 
The  reduction  involves  the  same  steps  of  extension  and  counter- 
extension  performed  in  the  same  manner,  with  the  patient  subdued 
by  anesthetics. 

The  difference  between  the  reduction  of  a  dislocation  and  that 
of  a  fracture  consists  in  the  fact  that  in  the  former  the  object  is 
simply  to  restore  the  bones  to  their  true  normal  position,  with 
each  articular  surface  in  exact  contact  with  its  companion  surface, 
the  apparatus  necessary  afterwards  to  keej)  them  in  situ  being 
similar  to  that  which  is  eraployed  in  fracture  cases,  and  which  will 
usually  requu'e  to  be  retainei  for  a  period  of  from  forty  to  fifty 
days,  if  not  longer,  before  the  ruptured  retaining  ligaments  are  suffi- 
ciently firm  to  be  trusted  to  perform  their  office  unassisted.  A  vari- 
ety of  manipulations  are  to  be  employed  by  the  surgeon,  consisting 
in  pushing,  pulling,  pressing,  rotating,  and  indeed  whatever  move- 
ment may  be  necessary,  until  the  bones  are  forced  into  such  rela- 
tive positions  that  the  musdolar  contraction,  operating  in  just  the 
right  directions,  pulls  the  opposite  matched  ends  together  in  true 
coaptation,  a  head  into  a  cavity,  an  articular  eminence  into  a 
trochlea,  as  the  case  may  be.     The  "setting"  is  accompanied  by  a 


264  OPERATIONS    ON    BONES. 

peculiar  snapping  sound,  audible  and  significant,  as  well  as  a 
visible  return  of  the  surface  to  its  normal  symmetry. 

iSpecial  Dislocations. — AMiile  all  the  articulations  of  the  body 
are  Uable  to  this  form  of  injury,  there  are  three  in  the  large  animals 
which  may  claim  a  special  consideration,  viz: 

The  Shoulder  Joint. — We  mention  this  displacement  without 
intending  to  imply  the  practicability  of  any  ordinary  attempt  at 
treatment,  which  is  usually  unsuccessful,  the  animal  whose  mishap 
it  has  been  to  become  a  victim  to  it  being  disabled  for  life.  The 
suj)erior  head  of  the  arm  bone,  as  it  is  received  into  the  lower 
cavity  of  the  shoulder  blade,  is  so  situated  as  to  be  hable  to  be 
forced  out  of  place  in  foui-  directions.  It  may  escape  from  its 
socket,  according  to  the  manner  in  which  the  violence  affects 
it,  outward,  inward,  backward,  or  forward,  and  the  deformity 
which  results  and  the  effects  which  follow  will  correspondingly 
differ.  We  have  said  that  treatment  is  generally  unsuccessful. 
It  may  be  added  that  the  difficulties  which  interpose  in  the  way 
of  reduction  are  nearly  insurmountable,  and  that  the  appHcation 
of  means  for  the  retention  of  the  parts  after  reduction  would  be 
next  to  impossible.  The  prognosis  is  svifficiently  grave  from  any 
point  of  view  for  the  luckless  animal  with  a  dislocated  shoulder. 
The  Hip  Joint. — This  joint  partakes  very  much  of  the  char- 
acteristics of  the  scapulo-humeral  articulation,  but  is  more  strongly 
built.  The  head  of  the  thigh  bone  is  more  separated,  or  promi- 
nent and  rounder  in  form,  and  the  cup-like  cavity  or  socket  into 
which  it  fits  is  much  deeper,  forming  together  a  deep,  true  ball- 
and-socket  joint,  which  is,  moreover,  re-enforced  by  two  strong 
cords  of  funicular  ligaments,  which  unite  them  together.  It  will 
be  easily  comprehended,  from  this  hint  of  the  anatomy  of  the  re- 
gion, that  a  luxation  of  the  hip  joint  must  be  an  accident  of  com- 
paratively rare  occurrence.  And  yet  cases  are  recorded  in  which 
the  head  of  the  bone  has  been  affirmed  to  slip  out  of  its  cavity 
and  assume  various  positions,  inward,  outward,  forward,  and  back- 
ward. 

The  indications  of  treatment  are  those  of  all  cases  of  dislocation. 
"\Mien  the  reduction  is  accomplished  the  surgeon  will  be  apprised 
of  the  fact  by  the  peculiar  snapping  sound  usually  heard  on  such 
occasions. 

T*seudo  luxations  of  the  Patella. — This  is  not  a  true  disloca- 
tion.    The  stifle  bone  is  so  peculiarly  articulated  with  the  thigh 


DISLOCATIONS.  265 

boBe  that  the  means  of  union  are  of  sufficient  strength  to  resist 
the  causes  which  usually  give  rise  to  luxations.  Yet  there  is  some- 
times discovered  a  peculiar  pathological  state  in  the  hind  legs  of 
animals,  the  effect  of  which  is  closely  to  simulate  the  manifestation 
of  many  of  the  general  symptoms  of  dislocations.  The  peculiar 
pathological  condition  originates  in  muscular  cramjDs,  the  action 
of  which  is  seen  in  a  certain  change  in  the  coaptation  of  the  artic- 
ular surfaces  of  the  stifle  and  thigh  bone,  resulting  in  the  exhibi- 
tion of  a  sudden  and  alarming  series  of  symjitoms  which  have 
suggested  the  phrase  of  "stifle  out"  as  a  descriptive  term.  The 
animal  so  affected  stands  quietly  and  firmly  in  his  stall,  or  per- 
haps with  one  of  his  hind  legs  extended  backward,  and  resists 
every  attempt  to  move  him  backward,  and  if  urged  to  move  for- 
ward he  will  either  refuse,  or  comply  with  a  jump,  with  the  toe 
of  the  disabled  leg  dragging  on  the  ground  and  brought  forward 
by  a  second  effort.  There  is  no  flexion  at  the  hock  and  no  motion 
at  the  stifle,  while  the  cii'cular  motion  of  the  hip  is  quite  free.  The 
leg  appears  to  be  much  longer  than  the  other,  owing  to  the  straight- 
ened position  of  the  thigh  bone,  which  forms  almost  a  str.iight 
line  with  the  tibia  from  the  hip  joint  down.  The  stifle  joint,  is 
motionless,  and  the  motions  of  all  the  joints  below  it  are  more  or 
less  interfered  with.  External  examination  of  the  muscles  of  the 
hip  and  thigh  discovers  a  certain  amount  of  rigidity,  with  perhaps 
some  soreness,  and  the  stifle  bone  may  be  seen  projecting  more  or 
less  on  the  outside  and  upper  part  of  the  joint. 

This  state  of  things  may  continue  for  some  length  of  time  and 
untn  treatment  is  applied,  or  it  may  spontaneously  and  suddenly 
terminate,  leaving  everything  in  its  normal  condition,  but  perhaps 
to  return  again. 

Pseudo-dislocation  of  the  patella  is  likely  to  occur  imder  many 
of  the  conditions  which  cause  actual  dislocation,  and  yet  it  may 
often  occur  in  animals  which  have  not  been  exjDosed  to  the  or- 
dinary causes,  but  which  have  remained  at  rest  in  their  stables. 
Sometimes  these  cases  are  referred  to  falls  in  a  slippery  stall,  or 
perhaps  shpping  when  endeavoring  to  rise ;  sometimes  to  weakness 
in  convalescing  patients  ;  sometimes  to  lack  of  tonicity  of  structure 
and  general  debility;  sometimes  to  relaxation  of  tissues  from 
want  of  exercise  or  use. 

The  reduction  of  these  displacements  of  the  patella  is  not 
usually  attended  with  difficulty.     A  sudden  jerk  or  si^asmodic 


266  OPERATIONS    ON    BONES. 

action  will  often  be  all  that  is  required  to  spring  the  patella  into 
place,  when  the  flexion  of  the  leg  at  the  hock  ends  the  trouble  for 
the  time.  But  this  is  not  always  suiEcient,  and  a  true  reduction 
may  still  be  indicated.  To  efi'ect  this  the  leg  must  be  drawn  well 
forward  by  a  rope  attached  to  the  lower  end,  and  the  patella, 
grasped  with  the  hand,  forcibly  pushed  forward  and  inward  and 
made  to  sHp  over  the  outside  border  of  the  trochlea  of  the  femur. 
The  bone  suddenly  slips  into  positiou,  the  excessive  rigor  of  the 
leg  ceases  with  a  spasmodic  jerk,  and  the  animal  may  walk  or  trot 
away  without  suspicion  of  lameness.  But  though  this  may  end 
the  trouble  for  the  time,  and  the  restoration  seem  to  be  perfect 
and  permanent,  a  repetition  of  the  entire  transaction  may  subse- 
quently take  place,  and  perhaps  from  the  loss  of  some  portion  of 
tensile  power  which  would  naturally  follow  the  original  attack  in 
the  muscles  involved,  the  lesion  might  become  a  habitual  weakness. 
Warm  fomentations  and  douches  with  cold  water  will  often 
promote  permanent  recovery,  and  liberty  in  a  box-stall  or  in  the 
field  will  in  many  cases  insure  constant  relief.  The  use  of  a  high- 
hepled  shoe  is  recommended  by  European  veterinarians.  The  use 
of  stimulating  liniments,  with  frictions,  charges  or  even  severe 
blisters,  may  be  resorted  to  in  order  to  prevent  the  repetition  of 
the  difficulty  by  strengthening  and  toning  up  the  parts. 

AMPUTATIONS. 

To  amputate  is  simply .  to  cut  off.  In  veterinary  surgery  it 
comprehends  the  removal  from  the  body  of  an  animal  of  one  or 
more  of  its  projecting  parts,  as  a  portion  of  a  leg,  or  an  entire  ex- 
tremity; the  horns,  the  ears,  the  penis,  the  tail,  etc.  From  the 
nature  of  the  case  it  involves  a  degree  of  deformity,  greater  or  less, 
with  a  loss  of  the  function  of  the  severed  member. 

The  difference  between  amputation  and  extirpation  has  respect 
only  to  the  organs  or  members  which  become  subject  to  the  opera- 
tion. The  parts  already  referred  to  are  amputated ;  the  organs  or 
members  liable  to  extirpation  have  theii'  seat  in  the  interior  regions, 
as  the  testicles,  the  ovaries,  and  even  the  uterus,  in  females,  and 
any  other  non-vital  organs  or  morbid  growths,  including  some  of 
the  glandular  structures,  more  particularly  the  lymphatic. 

Amputations  in  domestic  animals  are  of  two  classes :  In  one 
case  they  are  performed  at  the  dictate  of  a  capricious  fashion,  for 


AMPUTATIONS. 


267 


ilic  allegecl  purpose  of  improving  the  appearance  of  the  animal, 
and  are  performed  upon  parts  of  only  secondary  and  accessory 
functional  importance,  and  which  may  be  removed  almost  with  im- 
punity, as  the  ears,  the  tail  or  the  hoi-ns. 

In  the  second  class,  the  subject  is  brought  under  the  general 
laws  governing  diseases  and  remedies,  and  they  are  practiced  only 
as  it  becomes  necessary  by  the  existence  of  diseased  conditions  in 
important  organs,  such  as  the  penis,  the  tongue  and  the  locomotory 
organs.  In  this  class  the  serious  nature  of  the  operation  must  be 
measiu'ed  by  the  importance  of  the  function  fulfilled  by  the  organ 
implicated. 

The  instruments  necessary  for  the  operation  are  amputating 
knives,  similar  to  those  used  in  human  surgery,  or  more  commonly 
those  belonging  to  our  veterinary  work,  a  strong,  convex  bistoury. 


Figs.  286,  2Sr.— Amputating  Knives. 


Fig.  28S.— Amputating  Saw. 

which  is  generally  sufficient,  an  amputating  saw,  means  of  tem- 
jiorary  hemostasis,  cord,  an  elastic  band  or  ligature,  needles, 
sutvires  and  artery  and  dissecting  forcej^s. 

For  dressings,  balls  and  pads  of  oakum  of  various  sizes,  com- 
pri^sses  and  antiseptic  washes  are  needed. 

In  the  present  chapter  we  shall  limit  our  consideration  to  the 
amputation  of  the  legs,  the  horns  and  the  ears. 


268  operations  on  bones. 

Amputation  of  Members  or  Limbs. 

The  amputation  of  the  Hmbs  of  animals  is  a  matter  of  much 
less  importance  than  a  similar  mutilation  would  be  in  human  sur- 
gery, and  its  occurrence  is  relatively  much  less  frequent,  being 
necessarily  limited  by  the  exclusion  of  that  large  class  of  subjects 
whose  usefulness  would  necessarily  be  lost  by  the  total  impaii-ment 
of  their  organs  of  locomotion,  thus  rendered  unfit  for  their  work, 
and  even  when  it  is  indicated  for  animals  designed  for  food  con- 
sumption, the  question  becoming  pertinent  whether  it  would  not 
be  wiser  and  more  profitable,  in  a  large  majority  of  cases,  as  it 
would  unquestionably  be  more  humane,  to  deliver  them  at  once  to 
the  butcher,  before  subjecting  them  to  a  painful  mutilation  which 
must  necessarily  more  or  less  impair  their  condition,  and  therefore 
materially  diminish  their  market  value. 

As  a  matter  of  fact,  it  is  principally  upon  dogs  that,  in  ordinary 
circumstances,  the  veterinarian  is  called  to  operate  in  this  manner, 
as  even  in  his  mutilated  condition,  he  may  continue  to  be  able  to 
fulfil  many  of  his  duties  as  one  of  the  domestic  animals.  But  still 
there  are  circumstances  in  respect  to  animals  other  than  the  dog, 
under  which  the  operation  may  be  indicated  and  rationally  prac- 
ticed, as  when  the  life  of  a  valuable  animal  is  to  be  saved  on  account 
of  his  desirable  qualities  as  a  breeder,  and  which  may  not  be  dis- 
abled from  his  special  function  by  the  lack  of  a  limb.  A  valuable 
ram  or  bull,  a  high-bred  ewe  or  cow,  or  perhaps  also  a  mare  or  a 
stallion,  may,  for  such  a  reason,  become  proper  subjects  for  an 
amputation. 

But  even  under  these  conditions,  other  considerations  of  impor- 
tance must  not  be  overlooked,  and  whether  it  is  a  fore  or  a  hind 
leg  which  must  be  sacrificed,  will  be  a  point  of  great  weight  to  be 
considered  in  deciding  for  or  against  the  operation.  A  female 
with  only  three  legs  may  yet  carry  a  foetus  to  term,  and  be  fat- 
tened and  put  in  good  condition  before  being  sold  for  meat,  or 
may  possibly  be  covered  by  a  male ;  but  it  would  be  impossible 
for  the  stalUon  or  the  bull,  deprived  of  one  of  his  hind  quarters,  to 
mount  and  keep  the  raised  position  a  sufficient  time  to  complete 
the  act  of  copulation. 

Animals  of  small  size  and  weight,  being  more  supple  and  active 
in  their  movements,  suffer  least  from  the  loss  of  one  of  their  limbs. 
The  distance  from  the  mass  of  the  body  to  the  seat  of  the  ampu- 


AMPUTATIONS. 


269 


tation  is  also  a  consideratiou  of  moment.  A  reference  to  all  the 
reasons  will  necessarily  prove  that  of  all  domesticated  animals, 
the  horse  is  probably  the  one  upon  which  the  operation  is  least 
justifiable.  If  ever  to  be  performed  upon  him,  it  can  only  be  upon 
the  lower  regions  of  the  leg  close  to  the  ground,  inasmuch  as  the 
shortened  leg  can  still  be  made  useful  as  an  apparatus  of  support, 
either  directly  or  indirectly,  by  artificial  means. 

The  sum  of  the  matter  seems  to  be  embodied  in  the  following 
general  considerations  pertaining  to  the  question  of  the  amputa- 
tion of  the  limbs  of  our  domestic  animals : 

1st.  In  Dogs  it  is  indicated  in  diseases  of  both  bones  and  soft 
parts,  as  in  comminuted  fractures,  complicated  with  contused 
wounds  of  the  skin  or  other  soft  strictures ;  in  old  caries,  com- 
plicated with  suppurative  arthritis ;  in  osteo-sarcoma ;  in  the 
crushing  of  muscular  tissues  around  bones  and  their  complete 
separation  ;  in  extensive  gangrene,  as  that  resulting  from  the  ap- 
plication of  too  tight  a  bandage  ;  in  chronic  suppurative  articular 
disease ;  in  sloughs  of  soft  tissues  surrounding  the  exposed  bones  ; 
and  in  deep  cancerous  affections. 

2d.  In  Ovines. — Indications  are  offered,  as  in  dogs,  in  com- 
minuted fractures,  with  lacerations  of  soft  tissues,  and  more  com- 
monly in  complicated  phalangeal  arthritis. 

3d,  In  Bovines. — The  same  conditions  exist  as  in  the  smaller 
ruminants. 

ith.  In  Equines. — Amputation  is  indicated  as  a  means  of 
saving  an  animal  for  breeding  purposes  ;  in  complicated  fractures 
of  the  cannon  bone,  or  of  the  phalanges  ;  in  gangrene  of  the  digital 
organs;  extensive  abscesses  of  the  same  region,  with  softening  of 
tendons,  and  in  suppurative  arthi-itis.  It  is  also  sometimes  per- 
formed for  the  removal  of  a  supplementary  limb. 

5th.  In  Birds. — The  amputation  of  a  wing  or  even  of  a  leg 
can  be  performed,  either  to  prevent  flight,  or  to  relieve  a  diseased 
jDrocess  of  the  limb. 

But  in  all  cases  it  should  be  performed  upon  healthy  tissues, 
above  the  seat  of  the  disease,  and  at  the  greatest,  possible  distance 
from  the  trunk. 

The  number  of  cases  on  record  is  not  large,  and  they  are  prin- 
cipally reported  in  European  veterinary  journals.  In  these  we 
find  a  case  of  amputation  at  the  hock  in  a  ewe,  by  Chabert ;  in  a 
cow  at  the  knee,  by  Chaumontel;  in  an  ox  of  one  of  the  toes,  by 


270  OPEKATIONS    ON    BONES. 

Durant ;  in  a  dog  at  the  arm,  by  Fromage  de  Feugre ;  in  a  sheep^ 
in  a  case  of  foot  rot,  by  Lecoq;  in  a  mare  at  the  fetlock,  by 
Maurette ;  in  a  stallion,  on  the  third  phalanx,  by  Bouley ;  and  in 
English  jom-nals:  in  a  cow  in  the  metacarpal  region,  by  Laing;  a 
cow  on  the  hind  cannon,  by  Shield ;  and  on  a  mare  in  this  country, 
by  Huidekoper.  Others  are  reported,  which  were  attended  by  vari- 
ous degrees  of  success,  many  of  them,  however,  terminating  fatally. 
The  proper  mode  of  performing  the  operation  is  to  secure  the 
animal  in  the  decubital  position,  and  to  place  him  under  the  influ- 
ence of  general  anesthesia,  securing  temporary  hemostasis,  by  the 
application  of  the  circular  Hgature,  or  a  bandage  tightly  placed 
above  the  point  of  amputation,  or,  preferably,  by  using  the  process 
of  Esmarch,  which  seciires  a  more  perfect  removal  of  the  blood, 
and  enables  the  operator  to  perform  a  thoroughly  bloodless  opera- 
tion. Digital  pressure,  sometimes  recommended  for  the  smaller 
animals,  will  not,  however,  secure  as  good  a  result  as  that  obtained 
by  the  circular  ligature. 

The  operation  is  made  in  two  ways :  first,  in  the  continuity  of 
the  bones,  or  by  the  division  of  the  substance  of  the  bone  itself ; 
and  second,  in  their  contiguity,  or  at  the  nearest  sound  articula- 
tion.    This  last  is  also  called  disarticulation. 

All  amputations  consist  of  three  steps :  The  division  of  the 
soft  tissues,  that  of  the  bones,  and  the  arrest  or  prevention  of 
hemorrhage. 

2'he  First  Step,  the  Division  of  the  Soft  Tissues,  may  be  prac- 
ticed several  ways,  among  which  the  principal  are  the  cii'cular, 
elliptic  and  the  ovalar  methods,  and  that  by  flaps  ;  ail  of  which 
have  the  common  object  in  view,  of  leaving  a  flap  of  proper  form 
and  sufficient  dimensions  to  cover  the  stump  of  the  bone,  and 
prevent  its  projection  beyond  the  surface  of  the  wound. 

The  circular  method,  which  is  the  oldest,  consists  in  incising 
the  skin  m.  a  circular  manner,  stretched  over  the  surface  of  the 
region  with  the  left  hand  of  the  operator,  or  with  that  of  an  assibt- 
ant.  This  must  be  done  with  rapidity,  made  by  one  stroke  of  the 
knife,  apphed  as  perpendicularly  over  the  skin  as  possible. 

If  the  amputation  is  to  be  made  in  the  continuity  of  the  bones, 
the  skin  being  divided  while  stretched  by  the  assistant,  is  sepa- 
rated from  its  adhesions  underneath,  and  reversed  upward ;  when 
close  to  the  line  where  it  is  yet  adherent,  the  muscles  are  divided 
circularly,  by  one  stroke  of  the  knife,  drawn  to  the  bone.     These 


AMPUTATIONS  271 

muscles  spontaneously  retreat,  and  the  superior  stump  is  drawn 
upward  beyond  the  cutaneous  incision.  This  action  may  be  facil- 
itated by  separating  from  the  bone  whatever  attachments  may 
exist  between  them.  The  periosteum  is  thus  divided,  on  a  level 
with  the  retracted  muscles. 

The  amputation  in  the  contiguity  of  the  bones,  differs  from 
that  in  the  continuity  only  in  the  fact  that  when  the  section  of  the 
muscles  is  made,  there  is  no  division  of  the  periosteum  necessary, 
and  the  disarticulation  is  completed  with  either  the  bistoury  or 
amputating  knife,  or,  in  preference,  with  the  sage  knife.  The 
method  hy  flcqys  consists  in  making  on  one  or  both  sides  of  the 
bones,  one  or  two  flaps  of  skin  which  are  afterwards  united  to 
cover  the  stump,  and  form  the  new  surface. 

In  amputation  by  the  contiguity  of  the  bone,  the  method  to 
be  preferred,  and  which  may  be  practiced  both  from  within,  out- 
ward and  contrarywise,  is  this :  In  the  first  instance,  the  knife  is 
passed  through  the  soft  tissues  at  the  point  where  the  bone  is  to 
be  separated,  and  the  entire  mass  divided  by  drawing  the  instru- 
ment toward  the  operator  in  a  somewhat  oblique  direction.  In 
the  second  way,  or  from  without  inward,  the  flap  is  first  drawn 
with  the  point  of  the  knife,  and  then  dissected  from  without,  or, 
otherwise,  made  at  once  in  the  same  direction,  by  one  stroke  of 
the  instrument.  The  flaps  must  be  rounded,  not  angular,  at  their 
line  of  meeting,  and  in  such  a  way  that  the  amputated  wound 
will  represent  an  elliptic  inf  undibulum,  whose  center  is  occupied  by 
the  stump  of  the  bone,  surrounded  by  whatever  projecting  fleshy 
structures  may  be  brought  over  it  to  form  a  protective  cushion. 

The  second  step  of  the  operation  is  that  of  the  section  of  the 
bone,  or  of  the  articular  attachments. 

In  sawiag  the  bone  in  its  Continuity,  the  periosteum  being 
divided,  and  the  soft  tissues  protected  by  comjoresses,  some  little 
art  is  necessary.  The  saw  applied  perpendicularly  to  the  axis  of 
the  bone,  should  be  worked  slowly  at  first,  until  a  track  is  formed, 
after  which  the  movement  may  be  more  rapid.  Pressure  upon 
the  instrument  is  unnecessary,  if  it  has  been  properly  set.  Special 
caution  should  be  observed  in  finishing,  in  order  to  avoid  leaving 
rough  edges  to  be  cut  off  with  the  bone  forceps.  The  saw  must 
be  propelled  wholly  by  the  action  of  the  arm  of  the  surgeon,  his 
body  remaining  completely  motionless. 

"WTien  the  amputation  is  made   upon  the  segment  of   a  leg 


272  OPERATIONS    ON    BONES. 

which  has  two  bones,  though  they  may  be  divided  separately,  it 
will  be  preferable,  if  they  can  be  held  together  with  sufficient 
firmness,  to  act  upon  them  jointly,  but  finishing  the  smaller  bone 
first. 

The  actual  disarticiilation,  or  second  step  of  the  amputation, 
is  performed  by  dimiing  the  ligaments  or  other  structures  which 
surround  the  joint,  from  without  inward.  Beginning  with  the 
strongest  and  most  external  ligament  by  giving  a  movement  of 
semi-flexion  to  the  articulation,  not  necessarily  cutting  them  in 
their  middle,  the  joint  is  penetrated  by  inserting  the  knife  be 
tween  the  articular  surfaces.  The  double  sage  knife,  according  to 
Bouley,  is  the  most  convenient.  In  articidations  composed  of  ir- 
regular surfaces,  united  by  inter-articular  ligaments,  care  must  be 
taken  to  avoid  injuring  the  bones,  and  to  divide  the  fibrous  cords 
only,  as  most  of  the  synovial  capsules  must  be  removed,  in  order 
to  avoid  fistulous  compHcations. 

In  some  disarticulations,  according  to  Bouley,  it  is  necessary 
to  use  the  saw  to  remove  diarthodial  projections  on  the  surface  of 
the  amputated  bone,  which  if  left  in  place  would  prove  a  serious 
obstruction  to  the  cicatrization  of  the  stump 

The  last  step  of  the  operation  is  the  arrest,  or,  what  is  better, 
the^:>ret'e?i^io?i  of  the  hemorrhage.  It  consists  simply  in  twisting 
or  ligating  the  arterial  vessels  which  have  been  divided.  If  the 
means  used  for  the  temporary  hemostasis  prevent  the  operator 
from  discovering  its  source,  the  ligatures  can  be  slightly  relaxed 
until  it  is  betrayed  by  the  oozing  of  the  blood.  The  various 
methods  of  permanent  hemostasis  have  already  been  considered, 
and  need  no  further  description. 

In  the  application  of  a  dressing  to  the  wound  of  amputation, 
the  requu-ements  are  few,  but  they  are  imj)erative,  and  they  are 
sufficient,  assuring  the  best  results  by  theii'  simphcity  and  solid- 
ity. The  soft  tissues  and  the  skin  must  be  brought  together, 
over  the  extremity  of  the  bone,  and  kept  together  by  the  aj)plica- 
tion  of  a  continued  suture,  lea\Tng  a  place  of  drainage  for  the 
suppuration  and  the  sloughing  of  the  ligatures  which  occlude  the 
blood  vessels,  and  the  extremities  of  these  must  be  gathered  to- 
gether at  the  most  dependent  part  of  the  wound.  This  is  com- 
pleted and  protected  by  the  application  of  an  antiseptic  dressing 
consisting  of  pads  of  oakum,  absorbent  cotton,  or  threads  of 
tourbe,  kept  in  place  by  rollers,  and  supported  by  an  outside 


AMPUTATIONS. 


envelope  of  coarse  cloth.  The  wound  may  cicatrize  by  first  or  by 
second  intention,  according  to  the  severity  of  the  original  injury, 
as  well  as  to  the  amount  of  attention  bestowed  upon  the  antisep- 
tic apphcations  which  may  have  been  employed. 


Fig.  289.— Wooden  Leg  after  Amputation. 

CompHcations  are  not  uncommon  after  amputations,  though 
they  do  not  materially  differ  from  those  which  are  encountered  in 
other  serious  operations.  Among  those  which  may  be  mentioned 
are:  1st.  (Secondary  hemorrhage,  as  the  result  of  carelessness  in 
the  application  of  the  ligatures,  which  can  be  overcome,  however, 
by  immediate  or  lateral  compression,  or  by  the  renewal  of  the  lig- 
ature. 2d.  Abscesses,  of  various  dimensions,  resulting  from  the 
presence  of  the  ligatures  into  the  wound,  or  possibly  of  necrosis 
of  the  bone.  These  collections  are  to  be  treated  in  the  usual  way, 
as  are  also  undermining  of  the  skin  by  suppiu'ative  collections, 
phlehitis,  purulent  infection  and  gangrene,  all  of  these  being  con- 
ditions having  the  same  indications  as  in  other  forms  of  traumatic 
lesions. 

There  are,  however,  some  complications  which  belong  specially 
to  the  sequelae  of  this  operation,  such  as  may  result  from  an  im- 
proper section  of  the  bone,  which  might  end  in  the  formation  of 
a  conical  stump,  a  condition  which,  like  that  of  strangidation  of 
the  stump,  can  only  be  relieved  by  a  new  amputation,  with  a  bet- 


274  OPERATIONS    ON    BONES. 

ter  section  of  the  bone,  and  more  careful  attention  to  the  subse- 
quent dressing.  JV^ecrosis  of  the  amj^utated  bone  may  also  com- 
jjhcate  the  process  of  cicatrization,  accompanied  by  more  or  less 
pain  and  diffused  suppuration,  which  cannot  be  reheved  until  the 
necrotic  bone  has  sloughed  away. 

Amputations  in  the  contiguity  of  the  bones  are,  besides,  likely 
to  be  complicated  with  synovial  Jistulas,  which  may  be  of  an  ar- 
ticular or  tendinous  nature.  The  ordinary  forms  of  treatment  in 
similar  cases  will  be  sufficient  for  these. 

These  general  rules  regvilate  amputations  of  every  kind,  though 
the  various  steps  of  the  operation  may  have  somewhat  varied,  ac- 
cording to  circumstances.  But  whether  it  be  in  the  continuity 
or  contiguity  of  a  bone,  or  whatever  may  be  the  bone  involved ; 
whether  the  scapulo-humeral  joint,  the  fetlock  or  the  digital  re- 
gion ;  or  even  to  remove  supplementary  digits ;  they  are  of  equal 
applicability,  and  the  general  modus  operandi  remains  the  same. 
Even  in  the  operation  of  amjnitation  of  the  vnngs  we  find  but 
little  room  for  modification  or  change. 

In  operating  iipon  the  wings  of  birds,  with  the  j)rincij)al  object 
of  destroying  their  power  of  flight,  it  may  frequently  be  accom- 
plished by  simply  cutting  off  the  extremity  of  the  wing,  at  the 
carpal  articulation,  with  the  scissors,  and  cauterizing  the  wound 
with  perchloride  of  iron  or  nitrate  of  silver. 

Another  method  is  to  pull  out  the  feathers  from  the  inner  side 
of  the  wing,  as  far  as  the  elbow  joint,  the  skin  being  then  incised 
with  a  bistoury  somewhat  below  the  joint,  and  dissected  and 
reversed  upward,  the  bones  being  then  divided  with  the  bone 
forceps.  The  wound  should  be  carefully  washed  or  sponged  with 
cold  water,  to  check  the  bleeding,  and  the  skin  drawn  over  the 
stump,  secm-ed  by  interrupted  sutures.  The  bird  requires  no 
special  attention,  and  the  wound  heals  in  a  few  days. 

Amputation  of  Hokns. 

The  amputation  of  horns  is  an  operation  the  description  of 
which  dates  back  to  1790.  It  is  indicated  in  cases  of  fractures,  or  of 
vicious  growths  which  might  embarrass  the  motions  and  prevent 
the  usefulness  of  the  animal,  and  also  to  pro\dde  against  the  mu- 
tual injui-ies  which  cattle  are  liable  to  inflict  upon  one  another. 
It  is  also  indicated  in  cases  of  suppurative  collections  in  the  si- 
nuses, and  for  the  removal  of  parasites  from  those  cavities.    It  has 


AMPUTATIONS.  275 

of  late  not  only  assumed  a  place  among  the  operations  of  fashion, 
but  has  found  favor  from  its  alleged  tendency  to  improve  the 
quantity  and  quality  of  milk,  and  of  the  flesh  yielded  by  animals 
subjected  to  it.  It  is  in  relation  to  this  hypothesis  that  Gourdon 
considers  it  as  "a  great  progress  in  the  raising  of  horned  cattle, 
and  which,  on  account  of  the  benefits  that  may  be  derived  from 
it,  is  perfectly  justifiable."  The  operation  is  comparatively  a  sim- 
ple one,  but  nevertheless  involves  special  considerations,  varying 
according  to  the  sj^ecies  of  the  animal. 

1st.  In  Bovines. — If  only  the  free  extremity  of  the  organ  is 
to  be  cut  off,  it  is  done  with  the  saw  carried  rapidly  through  the 
horny  structure,  the  animal,  of  course,  being  proj)erly  secured. 
But  occasionally,  especially  in  cases  of  fracture,  the  section  is  to 
be  made  near  the  base,  or  the  middle  of  the  horn,  and  soft  and 
sensitive  tissu.es  are  also  involved.  The  amputation  must  then  be 
made  below  the  fracture  with  a  sharp  saw,  appHed  perpendicularly 
to  the  long  axis  of  the  horn,  and  completed  as  rapidly  as  possible. 

The  operation  will  be  accomj^anied  by  some  hemorrhage,  but 
not  sufficient,  usually,  to  require  the  ai)j)hcation  of  severe  hemo- 
statics. The  woimd  is  dressed  with  pads  of  absorbent  cotton, 
or  of  carbolized  or  antiseptic  oakum,  retained  by  compresses  or 
the  Maltese  cross  bandage.  Possible  collections  of  pus  must  be 
watched  for,  and  the  sinuses  should  be  carefully  cleaned  by  injec- 
tions. 

The  dressings  are  renewed  as  often  as  the  indications  require, 
and  continued  until  the  granulations  have  closed  the  cavities  of 
the  sinuses,  and  the  suppuration  has  almost  entirely  subsided. 
The  appHcation  of  a  permanent  dressing  in  the  form  of  a  pitch 
plaster  is  recommended  by  Gourdon.  It  need  not  be  removed, 
like  the  ordinary  dressing,  and  under  some  circumstances  is  of 
great  advantage. 

Among  the  probable  accidents  attendant  upon  this  operation, 
there  are  four  which  require  mention : 

(a)  Hemorrhages,  more  or  less  serious,  always  occur  after 
the  section  of  the  horn,  and  of  its  bony  support.  Usually,  it  is 
sufl&ciently  arrested  by  the  dressing  alone,  but  there  are  times 
when  the  appUcation  of  the  actual  cautery  becomes  necessaiy  to 
subdue  it. 

(b)  Inflmnmation  of  the  mucous  tnemhrane  of  the  sinuses  may 
also  foUow.     In  its  ordinary  manifestation  it  is  not  serious,  and  is 


270  OPERATIONS    OX    BONES. 

likely  to  terminate  either  by  resolution  or  even  suppuration,  though 
in  a  few  cases  it  may  be  followed  by  gangrene. 

(c)  Gangrene,  which  generally  manifests  itself  toward  the 
eighth  or  tenth  day,  ordinarily  ends  in  death,  and  is  often  accom- 
panied by  an  attack  of  ophthalmia  more  or  less  violent. 

(d)  Incomplete  cicatrization  of  the  stump,  occurring  principally 
in  cases  in  which  the  wound  has  been  neglected,  and  suffered  to 
remain  too  long  unj^rotected  by  a  dressing,  and  when  the  mucous 
membrane  of  the  horn  has  become  the  seat  of  chronic  inflamma- 
tion. A  central  fistula  usually  results,  accompanied  by  an  abun- 
dant suppuration,  which  is  apt  to  prove  exceedingly  intractable  to 
treatment. 

2d.  In  many  you7ig  ruminants  this  operation  is  performed  on 
calves  two  or  three  months  old,  and  consists  in  removing  the  rudi- 
mentary horns.  For  this  Charlier  has  invented  a  peculiar  tre- 
phine kind  of  cu'cular  gouge,  which  is  used  as  follows :  The  aui- 


FiG.  290.— Charlier's  Method  of  Amputation  of  Horns  in  a  Calf.    1st  Step. 

mal  being  thrown  and  held  by  two  assistants,  the  hair  is  cut  short 
around  the  base  of  the  horns,  and  the  trephine  ajDjilied  over  the 
horns  in  such  a  manner  as  to  divide  the  skin  and  subjacent  tissues 
down  to  the  frontal  bone  where  they  are  isolated  by  a  cii'cular  in- 
<'ision.  Then  by  a  downward  and  horizontal  twist  of  the  trephine 
the  di%dded  structures  are  gouged  out  and  the  secreting  matrix  of 


AMPUTATIONS.  277 


Fig.  291.— Charlier'a  Method  of  Amputation  of  Ilorns  in  a  Calf.    2d  Step. 

the  horn  removed.  The  hemorrhage  is  controlled  with  a  com- 
pressive bandage  or  other  hemostatic,  and  antiseptic  dressing 
applied.  The  wound  generally  heals  rapidly  and  without  compli- 
cations. 

Amputation  of  the  Tail. 

For  some  unexplainable  reason  the  term  "docking"  has  been 
apphed  to  this  operation,  which  is  simply  the  removal  of  some  of 
the  vertebrae  composing  the  caudal  aj)pendix.  It  is  one  of  the 
most  peculiar  among  the  operations  of  fashion,  although,  of 
course,  under  some  special  conditions  incident  to  all  animals,  it  is 
also  sometimes  performed  as  an  operation  of  genuine  beneficent 
surgery.  This  may  be  the  case,  for  example,  when  the  tail  is  abnor- 
mally so  long  and  hea\ry  as  to  interfere  with  the  usefulness  and 
comfort  of  the  animal,  or  when,  it  becomes  the  seat  of  disease  and 
becomes  affected  with  caries  or  necrosis,  or  fistulous  tracts,  or  af- 
fections of  the  skin.  In  some  instances,  also,  this  curtailing  oper- 
ation does  constitute  a  true  surgico-therapeutical  means  of  obtain- 
ing a  local  bleeding. 

Docking,  which  is  of  English  origin,  is  now  performed  all  over 
the  world,  and  has  given  rise  to  a  great  deal  of  controversy  upon 
the  question  of  its  propriety.  "Whether  it  is  an  act  of  inexcusable 
cruelty  or  not,  it  is  not  at  present  our  province  to  decide,  but  from  a 
surgical  point  of  view  we  feel  that  it  is  due  to  truth  to  say  that  we 
are  satisfied  that  a  gx^eat  deal  of  what  has  been  said  in  opposition 
to  the  operation  results,  from  the  various  and,  too  often,  bimgling 


'ZiQ  OPEKATIONS    ON    BONES. 

and  cruel  metliods  wliich  have  characterized  the  details  of  the 
amputation.  We  believe  that  some  of  these  methods  may  be  so 
modified  as  to  relieve  the  operation  of  its  apparent  character  of 
cruelty.  We  refer  now  especially  to  the  means  which  have  been 
and  are  employed  for  the  arrest  of  the  hemorrhage  which  is  likely 
to  follow  the  section  of  the  blood  vessels  of  the  region. 

The  tail  has  for  its  bony  support  a  series  of  the  caudal  verte- 
brae— from  fifteen  to  eighteen — varying  in  number  and  diminish- 
ing in  size  from  the  sacrum  to  the  end  of  the  organ,  and  imited 
by  a  thick  inter-vertebral  ligament,  and  attached  to  them  are  the 
caudal  muscles  in  pairs,  three  on  each  side,  the  siqyerlors  or  ele- 
vators, the  inferiors  or  depressors,  and  the  laterals  or  inclinators. 
Beside  these,  there  is  also  the  ischio-caudal  muscle,  which  extends 
from  the  ischiatic  ligament  upward  and  backward  to  terminate  on 
the  sides  of  the  first  caudal  vertebrae.  Between  each  of  the  lateral 
and  inferior  caudal  muscles  runs  the  lateral  caudal,  and  on  the 
median  line  between  the  inferior  muscles  the  median  caudal  ar- 
tery, all  running  to  the  end  of  the  tail,  and  likely,  when  divided, 
to  cause  a  more  or  less  troublesome  hemorrhage.  All  these  or- 
gans are  surrounded  by  the  caudal  aponeurosis,  from  the  deep 
surface  of  which  proceed  bands  which  form  a  special  sheath  for 
each  muscle,  and  is  ultimately  vmited  by  its  external  face  to  the 
thick  skin  which  surrounds  the  region.  This  skin  on  the  upper 
and  on  each  lateral  face  of  the  tail  is  covered  with  long,  thick, 
coarse  hair,  while  the  inferior  face  is  hairless,  smooth  and  com- 
paratively thin. 


Fig.  292.— Tail  Cutters. 


AMPUTATIONS. 


279 


Docking  properly  includes  three  steps :  1st,  the  preparation 
of  the  tail ;  2d,  the  amputation  ;  and  3d,  the  arrest  of  the  hemor- 
rhage. (There  is,  however,  a  mode  of  operation  in  which  the  last 
two  steps  can  be  merged  into  one.)  The  animal  is  kept  in  the 
upright  position,  and  well  secured. 

1st  Stq).  Preparation  of  the  Tail. — This  is  first  well  washed 
and  combed,  and  ought  to  be  cleaned  with  an  antiseptic  solution. 
The  place  where  the  amputation  is  to  be  performed  should  be 
marked  by  clipping  the  hair  from  it  in  a  circle,  and  above  this  the 
hair  should  be  secured  either  by  being  braided,  or  simply  tied 
tightly  in  a  mass  with  a  string  around  the  tail.  Some  practition- 
ers apply  a  cord  Ugature  or  an  elastic  bandage  above  the  place  to 
prevent  the  hemorrhage. 

2d  Step.  The  Amputation. — This  is  accomplished  by  several 
methods.  The  oldest  mode  was  by  using  a  simple  hatchet  as  the 
instrument  with  which  the  tail,  properly  prepared  and  laid  over  a 
wooden  block,  was  severed  by  a  heavy  blow  on  the  "  instrument." 
(Fig.  292). 


280 


OPERATIONS    ON    BONES. 


At  a  later  period,  special  knives  called  tail  cutters,  were  in- 
troduced. These  were  pecidiar  large  shears,  differing  more  or  less 
in  general  form  and  in  that  of  their  cutting  edges,  but  which  were 
used  in  the  same  manner,  and  are  stiU  in  common  use  by  many 
practitioners.  The  manner  of  using  them  is  very  simple.  The  tail, 
prepared  as  before  mentioned,  and  held  horizontally  by  an  assist- 
ant, is  so  placed  in  a  hollow  formed  in  the  edge  of  the  shears  as  to 
insure  a  perpendicular  stroke,  and  the  division  is  made  by  closing 
the  blades  with  a  single  quick  and  forcible  motion.  Other  instru- 
ments were  invented  to  work  by  springs. 


Fig.  296.— Spring  Tail  Cutter. 


Some  practitioners,  instead  of  dividing  the  entire  thickness  of 
the  organ,  prefer  to  do  so  by  disarticulating  the  vertebrae  with  a 
bistoury,  first  making  flaps  on  each  side  of  the  skin  in  order  to 
find  the  joint. 

3d  Ste}). —  To  stop  the  Hemorrhage. — The  moment  the  tail  is 
amputated  three  streams  of  blood  spring  from  the  stump,  with 
more  or  less  force,  according  to  the  position  of  the  member,  unless 
a  ligature  or  an  elastic  bandage  has  been  previously  apj^Hed.     In 


Fig.  297.— Tail  Cautery. 


AMPUTATIONS.  281 

either  case  attempts  may  be  made  to  ligate  or  to  employ  torsion 
of  the  arteries,  but  the  hemostatic  generally  employed  is  the  actual 
cautery.  The  tail-cautery,  heated  to  nearly  a  white  heat,  is  firmly 
held  upon  the  truncated  tail  for  a  few  seconds  until  it  has  stopped 

the  hemorrhage.  To  assist  this 
process  and  obtain  the  formation 
of  a  thicker  scab,  certain  com- 
bustible substances  are  some- 
times placed  upon  the  wound 
before  the  cautery  is  apphed,  to 
increase  the  heat  by  their  igni- 
tion. A  ring  of  hair  or  a  little  pulverized  resin  may  be  employed 
for  this  purpose. 

We  have  before  noted  that  in  this  measure  of  hemostasia  there 
is  much  that  is  repulsive  and  coarse,  and  that  it  is  not  at  all  in  har- 
mony with  the  spirit  of  modern  scientific  surgery,  and  we  have 
long  felt  a  conviction  that  a  great  improvement  is  possible  in  the 
manipvdation  of  such  a  case.  We  have,  therefore,  made  the  matter 
one  of  careful  experimentation,  and  the  conclusion  we  have  reached 
is  that  the  following  course  of  procedure  will  meet  all  the  indica- 
tions and  fulfil  all  the  purposes  contemplated,  and  at  the  same  time 
avoid  the  comphcations  Ukely  to  occur,  and  obviate  the  objections 
of  the  sensitive  and  the  timid,  besides  securing  results  entirely 
satisfactory  to  all  the  parties  concerned. 

First,  to  render  the  operation  painless,  we  inject  cocaine  at  two 
or  three  points  in  the  circumference  of  the  tail  skin.  Then,  around 
the  tail,  and  above  the  ring  made  by  clipping  the  hair,  as  before 
mentioned,  to  mark  the  place  of  amjDutation,  we  place  a  narrow 
elastic  band  at  a  tension  merely  sufficient  to  stop  the  hemorrhage. 
Having  waited  for  the  full  effect  of  the  anesthetic,  and  accurately 
identified  the  center  of  the  articulation  between  two  of  the  vertebrae 
through  which  we  intend  to  amputate,  with  a  strong  and  sharp 
bistoury  we  make  rapidly  a  circular  incision  of  the  skin  entirely 
around  the  tail,  and,  if  possible,  divide  the  causcle  with  a  single 
stroke  through  the  intervertebral  ligament.  With  a  little  care  and 
practice  the  amputation  may  be  completed  in  a  few  seconds,  and 
there  remains  at  the  end  of  the  tail  but  a  smooth,  perfectly  blood- 
less stump.  We  cover  the  fresh  surface  with  a  dressing  powder, 
antiseptic,  caustic  or  astringent  as  indicated,  and  leave  the  patient 
eating  his  oats  as  he  had  been  doing  during  the  operation,  unaware 


282  OPERATIONS   ON    BONES. 

of  the  mutilation  to  which  he  has  been  subjected.  We  leave  the 
elastic  band  in  place  for  from  twenty-four  to  thirty-six  hours,  pos- 
sibly loosening  it  once  dming  that  time,  or  tightening  it,  if  any 
oozing  of  blood  is  discovered,  and  removing  it  entirely  as  soon  as 
it  becomes  safe  to  do  so. 

The  stump  generally  needs  no  special  care,  except  in  cases  of 
possible  complications  which  may  follow  the  operation.  The  am- 
putation of  the  tail  by  flaps  is  also  performed  by  some  veterinarians 
with  great  success,  this  mode  leaving  a  wound  which  generally  heals 
very  rapidly  and  without  the  ordinary  possibility  of  comj^Ucation. 

Among  these  are,  first,  hemorrhage.  The  occurrence  of  this 
is  an  evidence  that  the  hemostasia  has  been  imperfect,  proba- 
bly the  cauterization  has  not  been  sufficiently  thorough;  or  the 
torsion  of  the  arteries  has  been  insufficient ;  or  the  Hgature  has 
been  loosely  tied.  This  accident  requires  a  repetition  of  the  man- 
ipvdation,  and  perhaps  another  cauterization  or  torsion  or  ligature. 
With  the  apphcation  of  our  elastic  band  this  can  scarcely  ever  oc- 
cur.    If  it  does,  another  turn  of  the  band  will  complete  the  work. 

Bad  aspect  of  the  Stump. — The  amputation  of  the  tail  by  sec- 
tion through  the  continuity  of  the  bone,  as  commonly  happens 
when  the  tail-cutters  have  been  used,  leaves  in  the  center  of  the 
wound  a  projecting  portion  of  a  vertebrae,  which  is  usually  bm-nt 
by  the  cautery,  when  this  has  been  used.  As  the  resiilt  of  this, 
and  surrounding  the  mortified  bone,  large  granulations  rapidly 
appear,  overlapping  the  circiilar  edges  of  the  wound,  and  char- 
acterized by  an  abundant  discharge.  The  necrotic  bone  must 
then  be  amputated  and  the  granulations  heavily  cauterized  with 
caustics  of  the  potential  kind ;  the  saturated  solution  of  chloride 
of  zinc  making  an  excellent  prescription  for  the  purpose  required. 
To  obviate  this  complication  the  operator  will  do  well,  when  any 
portions  of  vertebras  have  been  left  in  the  stiimp,  to  remove  the 
fragments  with  the  bone  forceps  rather  than  to  wait  for  their  re- 
moval by  the  natural  process  of  necrosis.  We  have  never  encoun- 
tered these  compiications  when  using  the  elastic  band,  being 
careful  to  amputate  at  the  articulation  of  the  vertabrse.  The 
powdered  di'essings  we  have  used  have  always  kept  the  granulations 
under  control. 

Multiple  Abscesses. — We  have  met  these  once,  as  the  result 
of  the  presence  of  a  very  thick  scab,  which  prevented  the  escape 
of  the  underljdng  suppuration. 


TREPHINING.  283 

Gangrene  and  Tetanus  have  also  been  recorded  as  sequelae  of 
this  operation. 

The  rules  we  have  given  apply  without  change  to  the  amputa- 
tion of  the  tan  in  smaller  animals,  as  sheep,  dogs  and  cats. 

TREPHINING. 

The  operation  of  trephining  or  trepanning  consists  in  boring 
into  or  through  a  bony  or  other  hard  structure,  in  order  to  form 
an  aperture  for  surgical  purposes.  Although  the  cranium  is 
usually  the  seat  of  the  opening,  it  may  be  made  ia  any  part  of 
the  body  where  the  indications  demand  it. 

The  application  of  the  trephine  or  of  terehration,  as  it  is  called 
when  it  is  performed  at  the  base  of  the  horns  of  cattle,  dates  back 
to  antiquity,  having  a  record  antedating  the  time  of  Hippocrates, 
and  yet  it  was  not  until  toward  the  year  1749  that  it  in  fact  entered 
the  domain  of  veterinary  surgery.  About  that  time  Lafosse,  Sr., 
performed  it  to  oj^en  the  frontal  and  maxillary  sinuses  in  the 
treatment  of  glanders  and  other  diseases  mistaken  for  it.  It  was 
afterwards  recommended  by  Greave  and  Haubner  as  the  proper 
treatment  for  the  reHef  of  purulent  collections  in  the  sinuses  of 
the  head,  and  it  has  been  recommended  by  many  others  for 
parasitic  affections  of  the  cranial  cavity,  as  cases  of  coenurus 
cerebraHs. 

Trephining  is  undoubtedly  indicated  in  many  pathological 
conditions,  and  in  fact  ought  to  be  more  frequently  practiced 
by  the  veterinarian  of  to-day.  Much  has  been  lost,  no  doubt,  by 
its  neglect  and  disuse.  Its  value  is  most  fully  demonstrated  in 
cases  where  it  becomes  necessary  to  remedy  the  effects  of  mechan- 
ical lesions  taking  the  form  of  bloody  or  purulent  gatherings 
within  the  cranium,  like  those  which  may  result  from  the  pressure 
of  fragments  of  fractured  bones  upon  the  brain.  Fractures  of  the 
cranial  bones  resulting  in  this  manner  are  not  common  with  our 
domestic  animals,  but  when  they  do  occur  they  are  always  of  a 
serious  nature,  and  too  often  are  beyond  remedy.  In  a  case  of 
remediable  character  the  removal  of  the  pressure  ujDon  the  men- 
inges by  trephining  and  cleansing  the  wound  from  the  matters 
which  produce  and  continue  it,  whether  bony  fragments  or  bloody 
extravasations,  is  the  treatment  indicated  before  any  other.  Yet 
as  experience  has  many  times  jn^oved  that  the  brain  is  able  to  sus- 
tain a  very  considerable  amount  of  2:»ressure  without  betraying 


284  OPERATIONS    OX    BONES. 

any  signs  of  inconvenience,  the  indication  of  trepliining  only 
becomes  absolute  when  serious  nervous  manifestations  are  ex- 
hibited. In  simple  contusions,  or  even  with  complete  fractiu-e  of 
the  bone,  trephining  is  not  indicated  unless  brain  lesions  are 
unmistakably  present. 

It  is  indicated  in  solipeds  in  cases  of  chronic  discharges  pi'o- 
ceeding  from  suppurative  collection  in  the  sinuses,  characterized 
by  a  yellowish,  grumous,  and  often  offensive,  running  at  the  nose, 
usually  from  but  one  side,  and  not  uncommonly  accompanied  by 
a  deformity  of  the  face,  caused  by  a  bulging  of  the  bones,  and 
associated  with  it  a  dullness  on  percussion  over  their  surface. 

Jessen  &  Unterburger  have  also  recommended  it  in  cases  of 
suppuration  in  the  cavities  of  the  nasal  turbinated  bones.  In  the 
treatment  of  chronic  catarrhal  inflammation  of  the  horns  or  of  the 
portions  of  the  frontal  sinuses  which  extend  into  the  appendix  of 
the  head,  in  ruminants,  it  has  given  excellent  results. 

It  is  also  indicated  for  the  removal  of  foreign  bodies,  either  of 
a  pathological  nature  or  the  product  of  wounds,  entering  the 
cranium  from  the  outside.  It  is  available  for  the  removal  of 
polyi^i  or  any  kind  of  neoplasm,  of  migrating  dental  cysts,  of 
odontomPB,  or  as  one  of  the  first  steps  in  the  operation  for  the 
removal  of  diseased  teeth  from  their  alveolar  cavity;  in  all  these 
cases  it  is  the  first  indication.  It  is  also  of  common  apj^lication  in 
extracting  parasites,  the  coenurus  especially,  from  the  cranial  cav- 
ity of  small  ruminants,  when  their  location  has  been  first  j)Ositively 
ascertained.  In  some  severe  cases  of  diseased  withers  accom- 
panied with  abundant  suppuration,  which  may  filtrate  under  the 
internal  surface  of  the  scapulfe,  and  accumvdate  between  that  bone 
and  the  thorax,  it  has  been  claimed  that,  performed  upon  the 
scapula,  it  would  f  m-nish  an  eligible  means  of  reaching  the  bottom 
of  the  collection,  and  providing  suitable  drainage  and  consequent 
relief. 

Trephining  the  wall  of  the  foot  in  special  cases  of  laminitis, 
to  assist  the  escape  of  the  effused  blood  from  between  the 
lamincB  has  also  been  tried,  but  with  what  results  we  are  not 
informed.  It  has  even  been  performed  in  the  treatment  of  immo- 
bility, but  so  far  as  we  have  learned,  has  never  been  followed  by 
satisfactory  results.  It  is  also  referred  to  in  connection  with  the 
cranial  inoculation  of  rabies,  as  j^erformed  by  Pasteur. 

The  special    instrument    employed    in   the  operation   is   the 


TKEPHINING. 


285 


trejyhine,  or  trepan,  in  various  modified  forms.  There  are  also 
others  which  may  be  considered  as  accessory,  viz.,  scissors,  bis- 
touries, forcejis,  bone-scrapers  and  elevators. 

The  brace  and  bit  trephine  is  the  orio-inal  instrument  which 
has  been  more  or  less  modified,  and  which,  while  it  is  capable  of 
more  rapid  execution,  is  probably  less  controllable  than  the  ordin- 


FiG.  ■,TO.— Bichat'8  Trephine. 


Fig.  293.-01d-Fa8hioned  Trephine. 


Fig.  300.— Single-Handed  Trephine. 


286 


OPEKATIONS    ON    BONES. 


Fig.  301.— Operation  of  Trephining.    Modus  Operandi. 


ary  trephine  (Fig.  300),  and  therefore  not  so  safe.  The  single- 
handed  trephine  is  also  to  be  preferred  from  the  fact  that  the 
former  requires  both  hands  to  manage  it,  while  the  latter  can  be 
manipulated  with  a  single  hand.  They  are  both  what  might  be 
properly  denominated  true  circular  saws,  if  judged  by  the  result 
of  their  appUcation,  which  is  the  removal  of  a  cii-cular  portion  of 
the  bony  structiu'e,  and  a  corresponding  round  ojDening,  through 
which  other  surgical  indications  can  be  fulfilled. 

A  simple  gimlet  has  often  taken  the  place  of  the  regular  instru- 
ment, but  such  an  appliance  can  be  considered  as  possessing  little 
more  than  the  character  of  a  mere  exploring  needle,  from  the 
impossibility  of  making  an  opening  with  it  of  sufficient  dimen- 
sions to  be  available  for  any  other  practical  use. 


TREPHINING. 


287 


The  hone-scrapers,  or  elevators,  whicli  are  sometimes  employed 
as  accessory,  are  used  for  preserving  the  periosteal  covering  of 
the  bones;  for  removing  the  rough  edges  of  the  opening;  or  in 


^^P 


Fig.  302.— Bone  Scrapers  and  Elevators. 

raising  the  bony  fragments  vi^hich  have  been  crushed  in,  or  may 
be  pressing  against  the  cerebral  substances. 

An  important  step  before  entering  uj^on  the  operation,  is  to 
determine  the  points  which  are  to  be  avoided.  Generally  speak- 
ing, any  part  of  the  head  or  of  the  body  can  be  oj)erated  upon,  so 
long  as  there  is  a  bony  sui-f  ace  that  can  be  readily  exposed  without 
danger  of  injuring  other  important  organs.  But,  upon  the  head, 
the  angles  of  bones  and  the  tl-acts  of  the  cranial  sutui-es  ought  to 
be  avoided.  In  the  more  common  apphcations  of  the  operation 
upon  the  head  (Figs.  303,  304),  one  of  four  princij^al  j^oints  is  gen- 
erally selected,  by  which  to  effect  an  entrance  into  the  cavities  of 
the  sinuses.  The  points  marked  h,  near  the  lower  borders  of  the 
frontal  bone,  will  open  the  frontal  sinuses :  the  point  c,  upon  the 
surface  of  the  nasal  bones,  communicate  with  the  sujDerior  part  of 
the  nasal  canities  in  the  upper  portion  of  the  turbinated  bone;  the 
points  e,  upon  the  zygomatic  bone,  will  enter  the  superior,  and  /', 
upon  the  great  maxillary  bone,  will  penetrate  the  lower  maxillary 
sinus.     Besides  these  specific  regions  upon  which  to  apply  the 


288 


OPERATIONS   ON   BONES. 


Fig.  303. 

Parts  of  the  Head  where  Trephining  : 


Pig.  304. 
Performed. 


instrument,  there  are  conditions  where,  the  bone  being  less  sub- 
cutaneous, the  operation  is  less  easily  performed.  Such  is  the 
case  as  to  the  lateral  faces  of  the  parietal  bone,  where  it  will  be 
necessary  to  penetrate  through  where  the  crotaphite  muscle  is. 
This,  however,  makes  a  compUcation  of  little  importance.  Again, 
there  are  indications,  such  as  in  cases  of  chronic  coryza,  with  sup- 
pvu^ation  of  the  sinuses,  where  a  double  trephining  becomes  neces- 
sary, one  to  enter  the  frontal,  and  the  other  the  superior  maxillary 
sinus.  Figure  305,  which  is  borrowed  from  Peuch  &  Toussaint, 
shows  the  exact  location  where  the  trephining  can  be  made. 
A,  entering  into  the  frontal;  B,  the  upper,  and  C,  the  lower  max- 
illary sinuses. 

The  modus  operandi  of  this  operation  is  very  simple.  Unless 
the  animal  is  very  restless,  and  cannot  be  controlled  by  the  ordi- 
nary means  of  restraint,  or  by  local  anesthesia,  and  must  there- 
fore be  cast,  or  unless  the  trephining  is  merely  the  first  step  of  an 
operation  to  remove  foreign  bodies  or  growths  from  the  sinuses,  or 
to  apply  special  action  upon  a  displaced  bone,  as  in  a  fracture,  we 
prefer  to  operate  in  the  standing  posture,  and  in  such  cases  have 
found  the  use  of  cocaine  of  great  advantage. 

In  any  case  the  skin  is  first  di\^ded  by  either  a  V,  or  a  T,  or  a 


TKEPHINING. 


289 


Fig.  305.— Common  Points  of  Selection  for  Trephining. 

semi-lunar  incision.  We  prefer  the  first  as  being  least  liable  to  be 
followed  by  a  blemish.  The  periosteum  is  divided  in  the  same 
form,  if  its  division  has  not  ah'eady  followed  that  of  the  skin. 
The  flap  thus  formed  in  two  structures  is  then  carefully  raised 
from  the  attachment  to  the  external  surface  of  the  bone,  and 
held  aside  by  an  assistant,  with  either  a  blunt  tenaculum  or 
forceps.  The  instrument  is  then  implanted  upon  the  centre  of 
the  exfiosed  bony  surface,  and  by  the  rotatory  or  semi-rotatory 
motion  imparted  to  it,  gradually  separates  a  circular  disk  of  the 
bone.  The  pressure  necessary  to  make  the  instrument  seize  or 
bite  on  the  bone  may  at  first  be  considerable,  but  as  the  trephine 
penetrates,  the  force"  must  be  carefully  relaxed  in  order  to  avoid 
the  hazard  of  injuring  the  j^arts  beneath  by  the  sudden  yielding 
of  the  bone  and  plunging  of  the  instrument  into  the  parts  beneath, 
accompanied  by  the  bony  disk,  as  it  separates  from  its  last  attach- 
ments, perhaps  passing  beyond  reach,  and  costing  no  Uttle  touble 
and  danger  before  it  can  be  discovered  and  removed. 

It  is  not  judicious  to  penetrate  through  the  bone  at  once.     As 
the  operator  feels  that  he  has  nearly  reached  the  last  turn,  the 


290  OPERATIONS    ON    BONES. 

safe  plan  will  be  to  j^artly  sej^arate  the  disk  with  a  partial,  obhque 
turn  of  the  trephine,  and  to  complete  the  separation  with  the 
elevator.  Sometimes  this  segment  will  be  retained  in  the  crown 
of  the  instrument,  or,  again,  it  will  be  only  jiartially  loosened.  In 
that  case,  securing  it  with  a  pair  of  bull-dog  forceps,  its  excision 
can  be  made  complete  with  the  bistoury,  by  dividing  the  mucous 
membrane  of  the  sinus  which  may  hold  it.  If  the  edges  of  the 
opening  in  the  bone  are  not  perfectly  smooth,  their  asperities 
should  be  removed  with  the  bone  scrapers  or  bone  knives. 

The  indications  following  the  perforation  of  the  bone  vary 
according  to  the  case.  If  it  is  a  fracture,  with  pushing  in  of  the 
bone,  the  fragments,  or  the  bone  debris,  must  be  removed  by 
being  raised  with  the  bone  elevator,  cutting  from  within  outward. 
If  a  removal  of  a  parasite  of  the  cranial  cavity  is  to  be  effected,  its 
membranous  envelopes  may  be  carefviUy  twisted  around  the  jaws 
of  the  forceps,  and  thus  removed  in  a  single  mass.  In  cleansing 
out  a  purulent  collection  in  the  sinus,  it  must  be  injected  and 
washed  with  the  proper  medicated  solution.  If,  on  the  contrary, 
the  removal  of  a  foreign  body  is  necessary,  as  a  polypus,  or  an 
odontoma,  or  the  extraction  of  a  molar  tooth  by  gouging,  it  may 
become  necessary  to  enlarge  the  opening.  This  is  done  either  by 
chipping  off  the  edges  with  the  bone  forceps,  or  by  making  another 
opening  with  the  trephine,  adjoining  the  first,  and  merging  them 
together  by  properly  trimming  and  shaping  them. 

The  dressings  required  after  trephining  vary  according  to  cir- 
cumstances. If  the  trephining  has  been  but  a  preliminary  step 
to  a  subsequent  manipulation,  such  as  the  raising  of  a  fragment 
of  fractm-ed  bone,  or  for  the  removal  of  foreign  bodies,  the  wound, 
after  beino-  thoroughly  and  antiseptically  washed,  can  be  closed 
by  bringing  the  edges  of  the  integument  together  by  sutures,  and 
covering  the  surface  with  a  pad  of  oakum,  kept  in  place  by  a  fig- 
ure 8  roller,  around  the  head,  or  by  one  of  the  frontal,  single  or 
double,  already  described.  If,  however,  the  operation  has  been 
performed  in  a  locality  where  there  would  be  difficulty  in  retain- 
ing such  a  dressing,  the  application  of  agglutinating  preparations 
or  plasters  will  effect  the  object. 

When  the  frontal  and  maxillary  sinuses  have  been  opened,  and 
it  becomes  necessary  to  wash  out  their  cavities  by  injections  thrown 
into  them,  the  trephined  opening  must  be  prevented  from  closing 
by  the  introduction  of  a  tent  of  oakum  and  a  kind  of  soft  cork, 


PEKIOSTOTOMY.  291 

which  may  be  kept  in  pLace  by  securing  it  to  the  halter  of  the 
l^atient,  to  prevent  it  from  falling  into  the  sinus. 

The  cicatrization  of  the  wound  made  by  the  trephining  in- 
strument springs  from  the  rapid  development  of  granualations 
which  soon  fill  up  the  opening.  These  granulations  soon  undergo 
the  various  changes  which  take  place  in  the  j^rocess  of  calcification 
and  ossification,  and  the  loss  of  bony  substance  is  soon  completely 
rej^aired. 

In  a  few  instances,  however,  the  seat  of  the  ojDeration,  after  a 
few  days,  assumes  a  most  unfavorable  aspect,  becoming  swollen 
and  ofiensive,  and  betraying  the  characteristic  necrotic  odor.  In 
many  instances  the  seat  of  the  necrosis  is  found  to  be  the  edge  of 
the  opening,  and  is  due  to  the  imperfect  appHcation  of  the  tre- 
phine, and  the  destruction  of  thej^eriosteum.  Care  must  then  be 
taken  to  remove  all  the  loose  necrotic  fragments.  To  allow  them 
to  remain  imbedded  in  the  granulations  and  under  the  skin,  wiU 
be  to  incur  the  certain  hazard  of  the  development  of  abscesses 
and  the  formation  of  fistulous  tracts,  which  will  refuse  to  heal 
until  the  last  particle  of  diseased  bone  has  been  exfoHated  and 
removed. 

PERIOSTOTOIVrY. 

Periostotomy  is  an  operation  which  consists  in  the  subcutaneous 
division  of  the  periosteum,  on  the  surface  of  bony  growths.  It 
may  be  for  the  purpose  of  stimulating  their  resolution,  or  it  may 
be  to  relieve  the  pain  arising  from  the  tension  of  the  inelastic 
membrane  as  it  is  pressed  upon  by  a  tumor  of  the  bone  growing 
under  it.  The  operation  was  originally  performed  by  Professor 
Sewell  of  the  Royal  Veterinary  College  in  1846,  and  was  at  first 
considered  to  be  one  of  the  neatest  and  most  scientific  among  the 
methods  practiced  for  the  rehef  of  the  lameness  due  to  exostoses. 
It  was  considered  by  Sewell  himself  to  be  far  sufierior  to  any 
other  means  then  in  use,  counter  irritations,  firing,  and  the  rest. 
But  although  earnestly  supported  by  the  authority  of  its  inventor, 
periostotomy  has  not  sustained  its  claims  by  exhibiting  all  the 
results  which  were  promised  for  it,  and  experience  has  shown  that 
it  is  in  many  instances  not  only  a  useless,  but  even  a  dangerous 
operation.  Several  special  instruments  are  necessary  in  its  per- 
formance. These  are  a  peculiar  roxoel  scissors  (Fig.  306)  to  incise 
the  skin,  for  which,  however,  a  special  bistoury  (Pig.  307)  is 


292 


OPERATIONS    ON    BONES. 


Fig.  306.— Scissors.       307.— Bistoury.     308.— Periostome.      309.— Seton  Needles. 

sometimes  substituted;  a  periostome  (Fig.  308),  a  kind  of  blunt 
bistoury,  narrow  and  curved;  and  two  flat  needles  (Fig.  309), 
short  and  curved  flatwise,  one  of  which  is  blunt,  and  used  to  di- 
vide the  connective  tissue,  the  other  being  sharp  and  to  be  used 
as  a  seton  needle  to  pass  a  tape  into  the  subcutaneous  incision,  if 
it  is  judged  necessary.  These  needles  may  either  be  inserted  into 
a  handle,  or  used  free. 

The  operation  is  a  simple  one  to  perform.  The  animal  being 
cast  and  properly  secured,  an  incision  is  made  with  the  rowell 
scissors  or  the  bistoury,  at  the  most  dependent  parts  of  the  bony 
growth,  large  enough  to  allow  the  introduction  of  the  blunt  curved 
needle.  This  being  pushed  slowly  under  the  skin,  separates  it 
from  its  attachments,  and  ui^on  being  gradually  withdrawn,  the 
periostome  is  passed  into  the  tract  thus  formed,  directly  over 
the  bony  tumor.  Turning  the  sharp  edge  of  the  periostome  on 
the  exostosis,  and  pressing  it  over  the  periosteum,  this  is  divided 
by  subcutaneous  strokes  down  to  the  most  superficial  layer  of  the 
exostosis,  which  may  be  incised  by  the  instrument. 

When  the  tumor  is  of  long  standing,  a  seton  may  be  intro- 
duced by  pushing  into  the  tract,  from  which  the  periostome  has 
been  removed,  the  curved  needle  which  carries  the  tape,  and  it  is 
brought  out  by  an  opening  made  at  the  highest  part  of  the  tumor. 

SeweU  claims  that  after  twenty-four  hours  the  parts  become 
the  seat  of  a  large  swelling,  and  more  or  less  inflammation  may  take 
place,  but  after  twelve  days  the  animal  is  ready  to  resume  his 
work,  the  swelling  ha\Tng  gradually  subsided,  and  the  lameness 


RESECTION    OF    BONES. 


293 


passing  off,  sometimes  tlie  enlargement  having  disappeared.  Our 
own  observation,  however,  differs  from  that  of  Sewell  and  agrees 
with  that  of  Reynal,  as  we  have  seen  cases  where  excessive  inflam- 
mation has  followed  the  operation,  accompanied  by  the  persistent 
development  of  large  indurated  swellings,  intractable  to  any  other 
form  of  treatment,  and  giving  rise  to  permanent  lameness.  This 
operation,  although  highly  recommended  by  English  practitioners, 
especially  in  the  treatment  of  splints,  is  not,  however,  held  in  the 
same  estimation  by  Continental  veterinarians. 

RESECTION  OF  BONES. 

The  resection  of  a  bone  is  the  removal  of  a  portion  of  its  sub- 
stance, for  the  connection  of  a  deviation  from  its  normal  position, 
or  other  deformity,  or  in  cases  of  fracture,  or  necrosis,  or  other 
incurable  disease.  It  is  to  a  bone  what  excision  is  to  the  soft 
tissues.  It  has  been  known  for  a  long  time,  but  it  is  within  only 
a  comparatively  recent  period  that  it  has  found  admission  into 
veterinary  surgery,  and  even  now  it  is  but  seldon  practiced.  It 
is  pi-acticable  on  all  parts  of  the  skeleton,  but  there  are  some 
special  conditions  in  which  it  is  more  e>idently  indicated  than  in 
others,  such  as  cases  of  necrosis  in  the  vertebrae,  giving  rise  to 
obstinate  fistulous  withers,  and  in  the  treatment  of  some  exostoses ; 
or  again  in  that  of  the  comphcated  wounds  accompanying  frac- 
tures. 


Fig.  310.— Various  Forms  of  Saws. 


294 


OPEKATIONS    ON    BONES. 


Fig.  312.— Bone  Forceps. 


Fig.  313.— Gouge. 


Fig.  313«.— ChiseL 


(I 


^9 


Fig.  3136.— Mallet. 


The  instruments  necessaiy  are  quite  numerous.  Saws  of 
different  forms,  including  the  chain  saw,  the  bone  forceps,  or 
shears,  the  gouge,  the  chisels,  and  the  mallets  are  all  brought 
into  requisition  at  times.  Before  making  a  resection  the  diseased 
bone  must  be  thoroughly  exposed  by  a  free  and  long  incision, 
giving  ample  room  to  the  surgeon  for  the  free  use  of  the  instru- 
ments. If  the  bone  is  akeady  exposed,  great  care  should  be  taken 
to  protect  the  soft  tissues,  the  muscles,  the  blood  vessels  and  the 
nerves,  from  being  accidentally  wounded,  by  covering  them  with 
compresses,  cloths,  or  other  substances. 


RESECTION    OF    BONES.  295 

The  manipulations  will  of  course  vary,  according  to  the  bone 
which  is  to  be  incised.  AVhen  one  of  the  long  bones  is  to  be  re- 
sected in  its  long  axis,  either  in  part  or  in  whole,  the  periosteum 
must  be  kept  as  nearly  intact  as  possible ;  as  the  jjrinciple  regen- 
erator of  the  osseous  tissue,  its  removal  would  necessarily  interfere 
with  the  cicatrizing  process.  It  must  be  very  careftdly  separated 
from  the  bone,  and  isolated,  to  the  whole  extent  of  the  segment 
to  be  removed.  This  done,  the  bone  can  be  readily  cut  off,  with 
either  the  chain  saw  or  the  plain  instrument.  The  resection  of 
bones  in  theii'  articular  extremities  seldom  occurs  in  our  practice ; 
it  sometimes  becomes  necessary  in  diseases  of  the  vertebrae,  in  fis- 
tulous withers,  and  occasionally  in  caries  of  the  ribs. 

In  the  first  case,  that  of  the  diseased  vertebrae,  the  excision  is 
commonly  made  with  the  bone  forceps  and  chisels,  or  even  with 
the  gouge.  The  principal  point  to  observe  in  these  instances  is 
to  avoid  injury  of  the  ligamentum  nuchoe  as  much  as  possible, 
and  to  save  all  the  periosteum  that  can  be  preserved. 

The  resection  of  ribs  is  accomplished  with  difiiculty,  on  account 
of  the  proximity  of  the  pleura  which  lines  their  internal  surface. 
To  avoid  woimding  this  important  organ  the  rib  is  exposed  by  a 
longitudinal  or  crucial  incision,  and  after  isolating  the  intercostal 
muscles  from  their  attachments,  the  pleura  can  be  pushed  away 
from  the  bone  with  the  blunt  end  of  a  scalpel,  and  with  the  chain 
saw  introduced  carefully  between  the  bone  and  the  pleura,  the 
resection  can  be  accomplished  by  dividing  the  bone  from  within 
outwards.  The  hemorrhage  which  arises  from  the  intercostal 
artery  can  be  stopped  by  plugging.  The  wound  is  dressed  by  a 
protective  antiseptic  bandage  applied  round  the  chest. 

The  general  indications,  after  the  resection  of  bones,  are  to  care- 
fully watch  the  progress  of  the  wound  and  watch  for  the  possibility 
of  the  formation  of  fistulous  tracts,  which  may  result  from  the 
extension  of  the  necrosis,  which  may  not  have  been  entirely  re- 
moved, or  may  result  from  the  removal  of  the  periosteum.  These, 
however,  may  often  be  prevented  by  so  regulating  the  process  of 
granulation,  as  to  prevent  the  accumulation  of  pus  in  the  wounds, 
and  if  necessary,  by  applying  caustics  or  resorting  to  any  other 
of  the  means  recommended  to  fulfil  the  existing  indications. 


CHAPTEK  VII. 

OPERATIONS    ON    MUSCLES    AND    THEIR 
ANNEXES. 

CAUDAL  IHYOTOMY. 

This  operation,  more  commonly  known  under  the  name  of 
pricking,  is  exclusively  performed  on  equiaes,  and  is  designed  to 
diminish  the  power  of  contraction  of  certain  of  the  muscles  of  the 
tail.  However  it  originated,  it  has  been  perpetuated  by  a  class  of 
horse  fanciers  who  have,  to  a  certain  extent,  made  it  a  dictum  of 
fashion,  and  by  whom  it  has  been  supposed  to  improve  the 
symmetry  of  the  animals  upon  which  it  is  inflicted  But  it  has 
lost,  in  oirr  day,  much  of  the  estimation  in  which  it  was  once 
held,  and  whUe  at  first,  before  its  prestige  had  been  weakened,  all 
kinds  of  horses,  indifferently,  became  victims  to  the  bad  taste 
and  thoughtless  cruelty  of  the  custom,  either  the  external  form  of 
our  horses  and  the  mode  of  attachment  of  their  tails  have  been 
improved  by  more  skillful  methods  of  breeding,  or  they  have  in- 
stinctively learned  the  regulation  style  of  carrying  their  caudal 
extremities.  Whatever  may  be  the  cause,  the  fact  is  beyond 
dispute  that  the  indications  for  the  operation  have  considerably 
diminished. 

But  though  the  effect  of  the  division  of  the  inferior  caudal 
muscles  is  in  fact,  with  some  animals,  to  cause  them  to  carry 
their  tails  in  lines  more  graceful  and  more  horizontal  than  before, 
it  is  still  necessary,  in  order  to  accomplish  a  successful  result, 
that  the  tail  should  be  properly  attached  to  the  body  as  a  con- 
genital arrangement,  or  well  set  up  on  the  sacrum.  A  horse 
with  an  obHque  sacrum,  with  the  tail  set  low  and  close  to  the 
ischial  tuberosities,  can  never  be  a  good  subject  for  the  operation, 
or  made  to  serve  as  a  favorable  example  of  the  beautifying  effect 
of  pricking. 

But  with  all  this,  there  is  sometimes  a  condition  which  (look- 
ing not  to  the  welfare  of  the  horse,  but  solely  to  the  conveniences 


CAUDAL    MYOTOMY.  297 

of  bis  master),  renders  caudal  myotomy  an  operation  of  necessity. 
This  occurs  with  those  animals  which  have  contracted  the  annoy- 
ing habit,  when  driven  in  harness,  of  switching  their  tails  over  the 
reins  and,  in  effect,  grasping  and  holding  them  so  tightly  that  it 
is  only  with  difficulty  that  they  can  be  extricated — often  placing 
the  driver  in  a  position  of  imminent  peril  by  making  it  impossible 
to  control  their  movements  at  a  moment  when  perhaps  a  disas- 
trous collision  or  other  dangerous  encounter  may  impend. 

There  is  also  another  condition  which  relieves  caudal  my otomy 
from  the  imputation  of  relying  for  its  justification  exclusively  on 
the  plea  of  being  in  the  fashion,  though  it  involves  only  the 
sordid  argument  of  a  money  consideration.  This  condition  is 
found  ill  the  case  of  the  animal  which  carries  its  tail  sidewise  or 
with  a  lateral  curvature — a  deformity  which  may  in  many  instances 
considerably  diminish  his  market  value.  In  other  words,  if  the 
contra-indication  of  the  operation  is  the  fact  of  bad  conformation 
of  the  animal  and  a  low  insertion  of  the  tail,  the  indications,  leav- 
ing aside  the  question  of  good  appearance,  no  matter  if  the  tail  is 
attached  low  or  high,  are  when  the  horse  has  the  habit  of  taking 
hold  of  the  reins  by  switching  it  over  them,  and  again  when  the 
tail  is  carried  crookedly  sideways.  We  proceed  to  consider  the 
operation  under  all  the  requirements. 

Caudal  Myotomy  Proper^  or  Pricking,  means  the  division  of 
the  two  inferior  sacro-caudal  muscles,  for  the  purpose  of  dimin- 
ishing their  contractile  j)ower.  It  is  performed  in  several  ways, 
most  of  which  consist  not  only  in  the  division  of  the  muscles, 
but  in  the  removal  of  a  portion  of  the  muscular  substance. 
There  is,  however,  one  method  of  which  we  have  failed  to  dis- 
cover any  mention  by  European  authors,  and  which  we  have  for 
years  practiced  in  the  United  States,  where  it  has  been  in  vogue 
for  a  period  of  more  than  forty  years.  This  mode  of  ojDeration 
Ave  shall  consider  in  another  place  as  the  "  American  method.'''' 
A  glance  at  plate  314  will  show  the  peculiar  anatomical  position 
of  the  muscles,  blood  vessels,  and  nerves  of  the  region  to  be  oper- 
ated upon.  Peuch  and  Toussaint  refer  to  six  modes  of  operations, 
but  we  think  the  matter  can  be  judiciously  simphfied  by  reducing 
the  number  by  at  least  one-half.  We  shall  therefore  adopt  a  sim- 
pler classification,  and  describe  the  operation  as  it  is  performed 
by,  ^r.s#,  the  transversal  incision;  second,  the  longitudinal;  and 
third,  the  transversal  and  longfitudinal  in  combination. 


298 


OPEBATIONS    ON    MUSCLES    AND    THEIR    ANNEXES. 


Fig.  314.— Anatomy  of  the  Perineal,  Anal  and  Caudal  Regions. 
1  1.— The  skin.  2.— Portion  of  the  aponeurotic  sheath  of  the  coo(>ygeal  muscles. 
3  3.— Inferior  sacro  coccygeal  muscles.  4  4.— Lateral  sacro  coccygeal  muscles.  5  5.— Is- 
chio  coccygeal  muscles.  6.— Suspensory  ligament  of  the  anus.  7  7.— Lateral  caudal 
arteries.  8.— Deep  caudal  vein,  satellite  ot  the  median  artery.  9.— ^Median  caudal 
artery.  10  10.— Inferior  caudal  nerves.  11.— Lymphatic  glands.  12  12.— Superficial 
caudal  veins.  12'— One  of  the  superficial  caudal  veins.  13.— Portion  of  the  perineal 
aponeurosis.  14  14.— Semi-membranosus  muscle.  15.— Sphincter  ani.  16  16.— Ischio 
cavernous  muscle.  17  17.— Bulbo  cavernous  muscle.  18  18.— Suspensoi-y  ligaments  ot 
thei)fniB.  19  19.— Bulbous  or  internal  pudic  arteries.  20.— Im-ision  of  the  urethral 
canal  lor  urethrotomy.    21.— Anus. 


CAUDAL    MYOTOMY. 


299 


The  patient  must  be  kept,  as  much  as  possible,  in  the  stantliug 
position,  with  a  twitch  on  his  nose,  and  his  hind  legs  hobbled,  or 
secured  with  the  hipj)o-lasso ;  or  if  he  is  of  a  very  excitable  and 
restless  disposition,  the  stocks  should  be  brought  into  requisition. 
The  decubital  position  is,  in  our  opinion,  unnecessary,  and  un- 
doubtedly a  very  inconvenient  one  for  the  surgeon,  and  not  at  all 
contributive  to  the  performance  of  a  neat  operation.  We  have 
often  used  cocaine  when  pricking  horses,  and  it  has  in  many  in- 
stances produced  all  the  excellent  effects  of  general  anesthesia; 
and  we  prefer  it,  therefore,  to  the  inhalations  of  chloroform  which 
some  recommend. 

1st.  Operation  by  Transverse  Incisions. — The  instruments 
required  in  this  mode  are  a  histouri  a  serpette,  an  instrument  re- 
sembling that  known  as  histouri  cache,  of  our   obstetric   cases; 


Fig.  315.— Bistoury  for  Caudal  Myotomy. 

a  sharp  convex  bistoury,  and  a  bull-dog  forceps,  or  a  pointed 
tenaculum.  The  animal  being  secured  in  position,  an  assistant, 
placed  on  one  side  of  the  croup  of  the  patient  and  facing 
the  operator,  raises  the  tail  perpendicularly  and  well  on  the 
middle  of  the  back  of  the  patient,  in  order  to  render  the  mus- 
cles tense  and  cause  them  to  project  well  under  the  fine,  soft 
sMn  which  covers  that  region.  The  operator,  directly  facing 
the  posterior  parts  of  the  animal,  then  firmly  grasps  the  tail  with 
his  left  hand  and  steadies  it,  while  holding  the  blade  of  the 
histouri  a  serpette  between  the  right  thumb  and  index  finger,  close 
to  its  sharp  part,  and  plunges  the  instrument  through  the  skin 
and  the  entire  thickness  of  the  muscle,  beginning  on  its  inside 
border,  or  slightly  on  one  side  of  the  median  line,  and  carrying 


Fig.  315a.— How  to  Hold  the  Bistoury  and  Make  the  Incision. 


300 


OPERATIONS    OX    MUSCLES    AND    THEIK    ANNEXES. 


the  incision  outward,  right  across  the  entire  width  of  the  muscle. 
The  incision  must  rvm  through  the  entire  thickness  of  the  organ 
and  ovight  to  be  made  by  a  single  stroke  of  the  instrument.  The 
first  incision  is  to  be  made  about  three  fingers  width  from  the  base 
of  the  tan ;  the  second  from  one  inch  and  a  half  to  two  inches 
back  of  it,  and  the  third,  if  not  considered  unnecessary,  at  the 
same  distance  from  the  second.  Owing  to  the  taj^ering  form  of 
the  tail,  the  incisions  should  become  shorter  as  they  approach  the 
end  of  that  member.  When  all  the  incisions  are  made  on  the 
right  side,  the  oj)erator,  if  ambidexter,  changes  hands  and  re- 
verses his  mode  of  manipulation,  proceeding  otherwise  in  the 
same  manner  as  before,  being  careful  that  all  the  incisions  are 
made  directly  in  line  with  one  another,  entirely  across  the 
muscle. 

These  first  three  incisions  constitute  the  first  step  of  the 
operation.  If  the  division  of  the  muscle  has  been  made  through 
its  entire  thickness,  the  portions  of  tissue  be- 
tween the  incisions  will  slightly  protrude,  and 
these  are  to  be  seized  with  the  bull-dog  forceps, 
and  drawn  over  to  one  side,  while  they  are  care- 
fully dissected  away  with  the  convex  bistoury, 
placed  flatwise,  under  the  muscle, 
with  the  sharp  edge  turned  up- 
ward, and  separating  entirely  the 
two  portions  of  muscles  included 
Fig  316 —Trans-  between  the  incisions.  The  amount 
versa!  Incisions  in  of  muscular  tissue  thus  removed 
Caudal  Myotomy.  ^^  measui'e  from  thi-ee  to  four 
inches  ia  length. 

The  number  of  the  incisions  varies.  At  first 
one  was  considered  sufficient,  but  the  number  was 
gradually  increased  to  five,  while  at  present  com- 
mon agreement  has  fixed  the  rule  at  three. 

2.  The  Operation  by  Longitudinal  Incisions. — 
This  is  comparatively  an  old  mode  of  operating, 
which,  havuig  been  once  abandoned,  was  revived 
by  Delafond,  in  1833,  when  it  was  again  reinstated 
in  general  practice.  It  requires  for  its  perform,  fig.  3i6«.— Cau- 
ance  only  a  stronnf,  convex  bistoury.     The  animal    ^^^  Myotomy  by 

.,     .  "^  _  °'  -^  _      ,  Longitudinal  In- 

being  secured  m  the  usual  position,  and   the  tail    cisions. 


CAUDAL    MYOTOMY. 


301 


kept  as  in  the  other  methods,  the  operator  makes  on  the  middle 
of  one  of  the  projecting-  muscles  a  longitudinal  incision,  three  or 
four  inches  long,  dividing  at  one  stroke  the  skin  and  the  fascia 
underneath.  From  the  muscle  thus  exposed,  a  j^ortion  is  dissect- 
ed, and  by  i:»assing  the  bistoury  under  it,  close  to  the  vertebrse,  it 
is  removed  b}^  cutting-  it  transversely  at  both  extremities  of  the 
cutaneous  incision.  The  removal  of  the  muscle  is  made  first  on 
one,  then  on  the  other  side  of  the  median  line. 

3d.  Operations  by  Mixed  Incisions. — This  was  devised  by 
Vatel,  who  made  two  transversal  incisions  on  each  side  of  the  tail, 
from  thi-ee  to  foiu'  inches  apart,  and  uniting  those  of  the  same 
side  by  a  longitudinal  incision,  made  in  the  direction  of  each  in- 
ferior caudal  muscle,  and  then  dissecting  a  portion  of  each  organ 
with  the  aid  of  a  bistoury,  or  a  pair  of  scissors,  securing  a  hold  at 
one  end  with  a  pair  of  forceps,  or  a  j^ointed  tenaculum. 

The  method  patronized  by  Brog- 
niez,  and  recommended  by  Belgian 
veterinarians,  requires  two  special  in- 
struments: the  caudal  dermatome, 
which  is  used  for  the  division  of  the 
skin,  and  the  caudal  myotome  for 
that  of  the  muscles.  The  operation 
is .  minutely  described  by  Director 
Degives,  and  includes  the  following 
stejDS : 

Two  or  three  incisions  are  made 
on  the  prominent  part  of  the  muscle, 
parallel  to  its  long  axis,  the  first 
about  two  fingers'  width  from  the 
base  of  the  tail,  a  space  of  about  half 
an  inch  being  left  between  each  in- 
cision. These  incisions  are  made  with  the  dermatome,  pressed 
perpendicularly  over  the  tissues  to  be  divided.  The  two  lower 
incisions  are  first  made,  then  the  two  middle  ones,  and  the  two 
upper  ones  last.  By  this  process  the  skin  and  subcutaneous  fascia 
are  divided.  The  myotome  is  then  introduced  under  the  muscle, 
from  within  outward,  and  after  twisting  it  around  the  organ,  di- 
vides it  by  turning  the  instrument  so  as  to  bring  its  sharp  edge 
against  the  muscular  tissue.  Thus  divided,  the  muscles  protrude 
through  the  incision,  and  are  then  excised  in  the  usual  way. 


Fig.  317.— Operation  ny  Mixed  In- 
cisions (Vatel's  method) 


302 


OPERATIONS    ON    MUSCLES    AND    THEIR    ANNEXES. 


Fig.  318.— Caudal  Der- 
matome. 


Pig.  319.— Cau- 
dal Myotome. 


Fig.  320.— Brogniez's  Mode  of 
Operation. 


The  American^  or  Subcutaneous  Method. — This  requires  but  a 
single  instrument,  viz.:  a  strong,  straight  tenotomy  knife.  The 
operator,  ha\'ing  the  animal  in  the  usual  position,  with  the  tail 
under  proper  control,  and  holding  his  knife  flat  full  in  the  hand, 
plunges  it  flatwise  through  the  skin,  with  the  sharp  edge  turned 
downward,  from  without  inward,  measuring  carefully  to  intro- 
duce it  at  about  the  sej)aration  of  the  lateral  and  inferior  caudal 
muscles,  and  pushing  it  as  nearly  as  possible  between  the  mass  of 
the  muscle  and  the  vertebrae.  When  the  instrument  has  pene- 
trated to  near  the  median  line,  the  sharp  edge  of  the  instrument 
is,  by  a  twist  of  the  hand,  turned  perpendicularly  in  the  direction 
of  the  muscle,  and  by  a  careful  sawing  motion,  the  division  of  its 
fibers  is  accomplished.  This  is  easily  detected  by  a  peculiar  crack- 
ing sound,  which  ceases  as  soon  as  the  entire  thickness  of  the 
muscle  is  divided.  The  edge  of  the  instrument  can  then  readily  be 
felt  under  the  skin.  The  cutting  must  be  carefully  done  in  order 
to  avoid  the  division  of  the  entu-e  thickness  of  the  skin.  A  second 
and  third  division  must  follow,  the  number  being  equal  on  each 
side. 

There  is  also  another  subcutaneous  mode,  practiced  by  Ger- 


CAUDAL    MYOTOMY.  303 

man  veterinarians,  but  which  is  claimed  by  Hering  to  be  uncertain 
as  to  its  results.  In  this  operation  both  a  straight  and  a  curved 
myotome  are  used.  With  the  straight  knife  a  small  incision  is 
made,  parallel  to  the  axis  of  the  tail  and  close  to  the  haii',  and  the 
curved  myotome  is  then  introduced  between  the  skin  and  the 
muscle.  A  turn  of  the  instrument  brings  its  edge  against  the 
muscle,  and  by  the  usual  sawing  motion,  the  organ  is  divided  from 
within  outwai'd,  the  blunt  end  of  the  myotome  sHding  upon  the 
vertebrae. 

Neither  of  these  subcutaneous  methods  include  the  removal 
of  any  portion  of  muscle. 

When  the  operation  is  finished,  the  animal  may  be  relieved  and 
the  tail  released  without  any  apprehension  of  serious  hemorrhage, 
although  by  reason  of  the  unavoidable  division  of  the  lateral  caudal 
arteries,  a  certain  amount  will  necessarily  take  place.  But  this  is 
not  of  a  serious  nature,  and,  as  a  rule,  needs  no  special  attention  ; 
we  have  seen  the  blood  which  had  flowed  quite  freely  while  the 
tail  was  hanging  pendant,  cease  almost  immediately  when  the 
animal  was  returned  to  his  stall,  and  the  tail  placed  in  the  position 
to  be  described  on  another  page.  But  in  case  of  an  unusually 
abundant  hemorrhage,  a  simple  compressible  bandage  may  be 
applied,  to  be  left  on  until  the  bleeding  is  controlled. 

The  treatment  appropriate  for  wounds  resulting  from  incision 
and  removal  of  portions  of  muscular  substance,  is  that  which  is 
common  to  all  suiDpurating  wounds,  cleanliness  being  the  most 
important  item.  AVhile  such  attentions  are  naturally  re  quired  for 
animals  subjected  to  any  of  the  various  methods  of  operation,  the 
subcutaneous  mode  can  claim  an  imj^ortant  advantage  in  the  fact 
that  the  heahng  process  is  almost  always  by  first  intention,  and 
the  tail  demands  no  subsequent  nursing. 

Whatever  may  have  been  the  method  of  operation  which  the 
animal  has  undergone,  it  will  be  subsequently  necessary  to  place 
the  tail  in  some  given  elevated  position,  and  retain  it  in  position 
for  a  term  ranging  from  two  to  possibly  four  weeks,  or  until  the 
wounds  are  cicatrized.  Various  devices  are  in  use  for  keeping  the 
tail  in  an  elevated  position,  the  simplest  and  probably  the  best  of 
which  is  that  of  the  pulleys.  The  proof  is  simple  ;  either  a  single 
pulley  is  placed  in  the  middle  of  the  ceiling,  or  two  are  used,  one 
on  each  side  of  the  stall,  and  in  either  case  about  on  a  level  with 
the  loins  of  the  animal.     The  tail  is  kept  in  the  perpendicular 


304  OPERATIONS    ON    MUSCLES    AND    THEIR    ANNEXES. 


Fig.  321.— Simple  Methodto  Keep  the  Tail  Elevated. 

position  by  a  cord  passing  through  the  pulley,  one  end  being  se- 
cured to  the  tail  and  the  other  to  a  weight  sufficiently  heavy  to 
effect  the  purpose  (Fig.  323).  A  httle  art  is  necessary  in  attaching 
the  cord  to  the  tail.  The  hair  should  be  nicely  braided  and  a  loop 
formed,  and  then  a  small  wooden  pin  run  through  the  braid  will 
effectually  prevent  the  cord  from  becoming  detached.     This  plan 


Fig.  322.— Brognlez'B  Apparatus  to  Elevate  the  Tail. 


CAUDAL    MYOTOMY. 


30^ 


Fig.  323.— Elevating  the  Tail  with  Pulleys. 


also  has  the  advantage  of  equalizing  the  strain  on  the  hair.  In 
respect  to  the  amount  of  weight  to  be  employed  in  this  process, 
much  caution  must  be  exercised  in  order  to  avoid  excess.  An 
error  here  might  cause  the  loosening  and  loss  of  the  hair,  with 
the  troublesome  consequences  of  greatly  interfering  with  the  final 
result  at  the  cost  also  of  much  suffering  to  the  horse.  The  cord 
should  run  freely  through  the  pulley  and  be  of  sufficient  strength 
to  allow  the  animal  to  lie  down  if  disposed  to  do  so.  It  will  be  a 
prudent  precaution  to  accustom  the  animal  to  the  use  of  the  j)ul- 
leys  by  placing  them  on  him  for  a  few  hours  daily  for  a  short  pe- 
riod in  anticipation  of  the  operation.  It  will  be  necessaiy — as  we 
before  remarked — for  the  horse,  after  that,  to  remain  in  the  pul- 
leys not  less  than  two,  and  possibly  three  or  four  weeks,  although 
after  a  short  time  he  may  be  relieved  for  the  pvirjDOse  of  taking 
proper  exercise.  The  Bartlet's  apparatus  recommended  by  G. 
Fleming  may  also  give  very  good  results  (Fig.  324). 

Caudal  myotomy  is  an  operation,  which,  though  simple  in  it- 
self, may  be  followed  hj  numerous  and,  at  times,  severe  compli- 
cations. Out  of  one  hundred  and  forty-one  animals  operated 
upon  by  Hering,  four  died  from  either  gangrene,  severe  petechial 
fever  or  suppurative  infection.  Among  the  most  common  acci- 
dents met  with  are  the  following  : 


306 


OPEKATIOXS    ON    MUSCLES    AND    THEIR    ANNEXES. 


Fig.  324.— Bartlet's  Apparatus,  Separate  and  in  Position. 


1st.  Hemorrhage^  which  is  not  generally  serious,  taking  j^lace 
mostly  when  the  tail  is  loosened  and  allowed  to  hang  down,  and 
ceasing  as  soon  as  it  is  again  placed  in  an  elevated  position.  It 
is  but  seldom  that  it  becomes  necessary  to  interfere  for  the  jDur- 
pose  of  arresting  it,  which  is  easily  effected  by  the  ordinary 
means,  as  pressure  or  the  ajDplication  of  hemostatics. 

2d.  Gangrene  is  one  of  the  most  dangerous  sequelae  of  the 
operation,  whether  resulting  from  excessive  traction  on  the  tail 
by  the  heavy  weights,  a  di-essing  too  tightly  applied,  or  excessive 
inflammation,  or,  according  to  Hering,  to  the  completed  section 
of  all  the  arteries  supplying  the  tail  "When  becoming  gangren- 
ous, the  wounds  assume  a  brown  or  blackish  appearance,  the  sup- 
puration becomes  sanious,  with  a  rejoulsive,  sui  generis  odor,  the 
tail  is  swollen  and  flabby,  and  the  oedema  surrounding  is  cold  and 
puffy.  The  gangrenous  process  generally  begins  toward  the  end  of 
the  tail  and  progresses  raj)idly,  endangei'ing  in  time  the  life  of 
the  patient.  It  is  often  only  by  the  most  energetic  measures  that 
it  can  be  controlled,  such  as  the  free  use  of  antiseptics,  scarifica- 
tion, cauterization,  or  even  amputation. 

3d.  'Wounds  of  the  Vertehrm  and  of  their  lAgaynents. — These 
injuries,  not  so  serious  in  their  character,  are  usually  produced 
by  the  contact  of  the  knife  during  the  operation,  causing  a 
scraping  of  the  bone  and  wounding  of  the  periosteum  or  the 
ligaments  which  unite  the  vertebrse.  Another  injury  is  a  re- 
sulting necrosis  caused  by  the  formation  of  a  fistula,  from  which 
a  thin  sanious  pus  is  discharged,  and  which  forms  a  wound  which 
refuses  to  cicatrize.  Though  Zundel  affirms  that  this  compHca- 
tion  is  most  common  after  the  subcutaneous  operation,  long 
experience  with  this  process  fails  to  justify  our  agreement  with 


CAUDAL    MYOTOMY.  307 

this  assertion.  "WTieu  disease  of  the  bones  exists,  the  indication 
is  to  promote  the  exfoHation  of  the  necrosed  parts  by  free  open- 
ings, antiseptic  di-essings,  and,  if  necessary,  caustic  injections. 
Anchylosis  of  the  vertebrae  is  a  common  sequel  of  this  complica- 
tion. 

4th.  Abscesses. — These  suppurative  collections  are  not  uncom- 
mon, especially  in  animals  having  peculiar  idiosyncrasies,  as  in 
cases  of  strangles.  They  may  extend  to  the  root  of  the  tail, 
around  the  anus,  or  any  part  of  the  hind  legs  even  to  the  rectal 
region.  They  require  treatment  similar  to  that  of  all  analgous 
gatherings. 

5th.  Anal  Fistulce. — This  accident  occurs  when  the  first  in- 
cision is  made  so  near  to  the  anus  that  it  enables  the  pus,  when 
it  forms,  to  filtrate  between  the  skin  and  the  rectum  into  the  pel- 
^dc  ca\T.ty,  and  is  a  condition  which  can  be  reheved  only  b}"  giving 
free  exit  to  the  collected  suppuration. 

6th.  Tetanus.  —  This  termination  can,  in  many  instances,  be 
avoided  by  antiseptic  measures  during  and  after  the  operation. 

7th.  l^he  introduction  of  air  into  the  veins  is  also  mentioned 
by  Loiset  and  Brogniez,  but  in  our  opinion  there  is  no  more  reason 
to  expect  its  occurrence  in  this  than  in  any  other  operation. 

8th.  Exaggerated  Elevation  of  the  Tail. — This  is  one  of  the 
most  common  of  all  the  sequelae  met  with.  In  this  case  the  tail, 
instead  of  being  carried  horizontally  and  hanging  gracefully,  is, 
on  the  contrary,  either  elevated  vertically,  or  even  laid  back  on 
the  croup.  This  is  not  j)recisely  due  to  imj)roper  manipulations 
during  the  operation,  but  is  rather  the  result  of  the  apphcation  of 
too  hea\y  a  weight  and  an  excessive  amount  of  traction  while  the 
animal  is  in  pulleys.  The  most  effectual  way  of  avoiding  this  un- 
pleasant incident  is  to  watch  closely  the  progress  of  the  cicatri- 
zation by  taking  the  patient  out  for  exercise  and  watching  the 
manner  in  which  he  carries  his  tail,  and  then  increasing  or  di- 
minishing the  weight  on  the  pulley,  and  shortening  or  lengthen- 
ing the  period  of  its  use. 

Operation  for  Abnormal  Deviation  of  the  Tail. — This  is  in- 
dicated where  there  is  a  lateral  curvature  of  the  tail,  and  the 
animal  carries  it  sidewise,  whether  it  be  a  congenital  habit  or 
occurs  as  one  of  the  complications  of  jjricking ;  and  also  when  he 
cai-ries  it  in  an  excessively  elevated  position.  In  these  cases 
myotomy  is  performed,  according  to  the  requirements,  either  on 


308  OPERATIONS    ON    :\IUSCLES    AND    THEIK    ANNEXES. 

the  lateral  caudal  muscle  on  the  side  to  which  the  tail  is  carried, 
or  upon  one  or  both  of  the  superior  sacro-caudal  muscles,  the 
elevators  of  the  tail.  As  a  rule,  one  incision  only  is  necessary, 
and  it  must  be  done  subcutaneously,  and  in  the  subsequent  treat- 
ment, instead  c  f  placing-  the  animal  in  pulleys,  the  tail  must  be 
tied  up  to  the  surcingle  on  the  side  opposite  to  that  of  the  opera- 
tion ;  or  it  may  be  allowed  to  hang  down  free.  An  experience  on 
our  part  of  many  years,  has  rendered  us  skeptical  as  to  the  success 
of  lateral  caudal  myotomy,  a  careful  dissection  of  the  tails  of 
animals  affected  with  this  deformity  having-  proved  the  existence 
of  an  abnormality  in  the  formation  and  development  of  the 
caudal  vertebrae  which  has  been  either  the  cause  or  effect  of  the 
trouble.  Operations  jDerformed  upon  animals  of  this  class  have 
not  been  usually  followed  by  a  satisfactory  result. 

CEUEAL  MYOTASE— CRURAL  MYOTOI^IY. 

This  affection  is  peculiar  to  bovines,  and  is  a  species  of  dis- 
location, or  displacement  of  the  long  vastus  muscle — the 
external  ischio-tihial.  It  is  a  lesion  which  forms  a  very  serious 
impediment  to  the  act  of  locomotion,  by  its  disabling-  effect  upon 
the  movements  of  the  hind  leg-. 

The  nature  of  crural  myotase  will  be  understood  by  those  who 
are  f amihar  with  the  anatomy  of  the  region  in  cattle.  With  them, 
the  bicej)s  femoris  covers,  in  its  normal  position,  the  whole  of  the 
coxo- femoral  joint,  in  such  a  manner  that  its  anterior  border  {a  b), 
Fig.  325,  is  situated  in  front  of  the  joint.  This  border,  from 
the  articulation  to  its  lower  end,  forms  a  kind  of  tendon,  (c) 
closely  connected  with  the  aponeurosis  of  the  fascia  lata,  (f)  whose 
divided  layers  surround  the  muscle,  adhering  intimately  to  its  two 
faces,  the  deep  and  the  superficial.  Passing  over  the  trochanter 
of  the  femur,  with  the  assistance  of  a  large  mucous  biirsa,  the 
biceps  is  quite  thin,  and  is  kept  in  position  by  an  aponeurosis  (c) 
which  partially  covers  the  gluteus  externus,  and  is  united  to  the 
fascia  lata. 

"^Tien  this  aponeurosis  is  lacerated  at  a  point  on  a  level  with 
the  hip  joiat,  while  the  leg  is  carried  backward,  in  excessive  ex- 
tension, it  is  possible  that  the  trochanter,  thus  carried  forward, 
may  become  engaged  in  the  laceration,  the  biceps  itself  being- 
hooked,  as  it  were,  behind  the  trochanter,  and  prevented  from  re- 


CEUKAL    MYOTOMY. 


309 


Pig.  325.— The  Biceps  Femoris  in  Cattle. 
Normal  Position. 


Fig.  326.— The  same  over  the 
Trochanter. 


turning  in  its  normal  direction.  This  accident  lias  been  noticed 
and  mentioned  in  the  remotest  ages.  It  may  result  from  both 
predisposing  and  occasional  causes.  Among  the  former  may  be 
reckoned  the  conformation  of  the  animal,  as  when,  for  example, 
the  croup  is  short,  flat  and  narrow,  the  hip  joint  not  prominent, 
and  the  trochanter  high.  Among  the  predisposing  causes  may 
also  be  included  that  of  leanness,  as  when  the  animal  is  thin  and 
in  poor  condition,  and  the  cellular  tissue  deficient.  The  combina- 
tion of  these  causes  renders  it  easy  for  the  muscle  to  slip  over  the 
trochanter,  now  relatively  prominent,  and  it  is  thus  that  the  dis- 
location occurs. 

Occasional  causes  also  call  for  mention.  These  include  all 
mischances  likely  to  bring  about  the  excessive  extension  of  the  leg, 
such  as  falls,  missteps,  slipping,  jumping,  kicking,  blows,  etc., 
any  of  which  may  thus  affect  the  limb  and  jDroduce  the  lesion 
under  consideration.  And  withal,  it  may  take  place  without  any 
^isible,  direct  and  efificient  agency  beyond  the  circumstance  of  the 
excessively  lean  condition  of  the  animal,  and  even  if  the  difficulty 
is  remedied,  and  the  displacement  is  reduced,  while  the  same 
state  of  things  continues,  there  is  a  constant  liability  to  a  return 
of  the  difficultv. 


310  OPERATIONS    ON    MUSCLES    AND    THEIK    ANNEXES. 

The  symptoms  characteristic  of  this  lesiou  are  readily  identi- 
fied. Principally,  there  is  great  difficulty  in  flexing  the  hip  joint. 
The  diseased  leg  is  dragged  on  the  ground,  carried  outward  and 
backward  and  the  animal  resting  it  on  the  ground  by  the  point  of 
the  hoof  only.  It  very  much  resembles  the  position  of  a  limb  of 
a  horse  suffering  with  a  dislocated  patella.  The  anterior  border 
of  the  muscle,  hooked  by  the  trochanter,  forms  a  longitudinal 
projection,  resembling  a  stretched  cord,  which  becomes  more  and 
more  mai'ked  when  examined  nearer  the  coxo-femoral  joint.  It 
can  be  made  more  prominent  by  raising  the  opposite  leg,  when  it 
will  be  found  extending  obliquely  downward  from  the  joint  to  the 
patella.  As  the  trochanter  is  no  longer  coyered  by  the  muscle, 
this  bony  eminence  becomes  directly  subcutaneous,  and  may  be 
readily  recognized,  holding  posteriorly  the  displaced  muscle, 
which  forms  a  kind  of  tvimor  behind  it. 

These  symptoms,  being  rarely  associated  with  inflammatory 
phenomena,  are  not  always  easy  to  detect.  There  are  cases  where 
the  lameness,  and  the  carrjdng  of  the  leg  outward  and  backward, 
are  the  only  aj)parent  symptoms.  The  lameness,  however,  is 
characteristic,  and  may  be  temporary  or  intermittent,  being  more 
severe  when  the  animal  is  traveling  up-hill  than  when  descending, 
but  remaining  the  same  on  both  soft  or  hard  ground ;  and  it 
sometimes  happens  that  while  the  animal  is  in  the  act  of  descend- 
ing, the  muscle  will  suddenly  return  to  its  place  with  a  claj^ping 
sound,  and  the  lameness  subside,  though  only  to  return  again  as 
soon  as  the  slightest  effort  is  required  of  the  animal,  and  his  hind 
leg  is  again  carried  backward  more  forcibly  than  usual.  This 
peculiar  intermittent  character  is  sometimes  the  cause  of  an  error 
of  diagnosis  w^hich  confounds  this  affection  with  the  dislocation 
of  the  patella,  but  the  exjDloration  of  the  stifle  will  always  serve 
to  establish  the  differential  diagnosis. 

This  accident  is  more  or  less  serious  in  its  consequences,  and 
is  particularly  detrimental  to  the  usefulness  of  working  animals. 
It  may  sometimes,  however,  subside  spontaneously  or  by  simple 
rest,  and  especially  if  the  condition  of  the  animal  is  improved  by 
good  feeding  with  fat-producing  fodder.  Sometimes  the  displace- 
ment is  comphcated  by  a  laceration  of  the  mucous  bursa  with  the 
formation  of  a  hygroma  of  warm,  painful,  oedematous  swellings, 
indicating  the  rupture  of  the  aj^oneurosis  or  the  inflammation  of 
the  cellular  tissue. 


CRUKAL    MYOTOMY.  311 

Generally  the  dislocation  is  unilateral,  but  in  other  cases  it  may 
occur  in  both  legs.  This  last  condition  is  always  of  a  serious 
natui-e,  and  seldom  responsive  to  treatment.  The  displacement  of 
the  biceps  femoris  seldom  recovers  naturally,  although  where  in- 
comi^lete  and  intermittent,  it  may  be  benefitted  by  long  rest,  or 
when,  as  we  have  before  remarked,  it  is  due  to  the  excessive  lean- 
ness of  the  patient,  in  which  case  a  hberal  fattening  diet  will  prove 
the  best  remedy,  by  removing  the  cause  of  its  appearance.  Local, 
external  topical  treatment  by  blisters,  plasters,  setons,  etc.,  are  of 
no  avail.  The  section  of  the  muscle  or  the  operation  of  crural 
myotomy,  is  the  indication.  The  modus  operandi  is  not  uniform, 
although  the  final  object  is  the  same  in  all. 

Oiu-  opinion  in  respect  to  the  best  way  of  operating  is  in  favor 
of  that  by  the  subcutaneous  section.  This  is  performed  below  the 
trochanter,  and  yet  as  near  to  it  as  possible,  where  the  excessive 
tension  of  the  hooked  muscle  can  readily  be  felt.  This  consists 
simj)ly  in  making  a  small  incision  through  the  skin,  by  which  to 
introduce  a  blunt  bistoury,  which  is  inserted  under  the  muscle, 
with  a  director  or  a  finger  for  a  guide,  and  when  at  a  proper  depth 
tiu'ned  to  bring  the  sharp  edge  towards  the  aponeurosis,  and  cutting 
it  from  within  outward,  carefully  avoiding  the  section  of  the  skin. 


Fig.  327.— Gouze's  Bistoury. 

The  bistoury  invented  by  N.  Gouze  answers  the  purpose  very  well. 
There  is  no  after-treatment  required  beyond  the  ordinary  care  re- 
quired for  all  wounds. 

Simple  as  the  operation  of  crural  myotomy  is,  some  compHca- 
tions  may  accompany  it. 

Hemorrhage  is  not  uncommon,  usually  subsiding  without  inter- 
ference, but  sometimes  requiring  the  application  of  hemostatics. 

Inter-Muscular  Abscesses. — Diffused  Suppuration. — These  are 
the  result  of  improper  manipulations  during  the  operation,  such 
as  lacerations  of  the  cellular  tissue  by  introducing  the  fingers  too 
frequently  into  the  wound,  or  dividing  the  muscle  in  several  places. 

Ganyrene. — Though  but  rarely  met  with,  this  should  be  re- 
membered among  the  possible  contingencies.     It  may  occur  as  the 


312  OPEKATIOXS    ON    MUSCLES    AND    THEIR    ANNEXES. 

result  of  the  presence  of  clots  of  blood  or  other  mortified  tissues 
in  the  wound,  and  is  indicated  by  the  bad  apj)earance  of  the  parts, 
the  pecuhar  oedematous  sweUiug,  first  warm  and  painful,  but  sub- 
sequently becoming  cool  and  painless.  This  condition  requires 
promjDt  and  efficient  treatment,  both  external  and  internal. 

In  /Solipeds. — We  once  had  occasion  to  resort  to  crural  myotomy 
for  the  reHef  of  a  case  of  pseudo-dislocation  of  the  patella  of  several 
months'  standing.  The  division  was  made  towards  the  lower  por- 
tion of  the  muscle,  and  was  followed  by  satisfactory  results,  though 
not  immediately. 


OPEKATIONS  UPON  FIBBOUS  TISSUES. 

Tenotomy. 

In  the  terminology  of  surgery,  tenotomy  means  the  sectiofi  of 
tendons — an  operation  which  contemplates  the  con-ection  of  de- 
formities, from  whatever  cause  they  may  proceed ;  the  relief  of 
pressure  upon  exostoses,  and  the  prevention  of  the  complete  execu- 
tion of  a  normal  function,  as  that  of  flj^ing  in  birds.  Our  atten- 
tion wiU,  accordingly,  be  directed  to  the  study  of  the  five  varieties 
oi  plantar,  carpal,  antibrachial  and  tarsal  tenotomy,  with  that  of 
the  icings  of  birds. 

Plantar  Tenotomy. 

This  operation  is  the  proper  remedy  for  the  deformity  known 
as  hmickling,  or  the  malposition  which  arises  from  the  exaggerated 
flexion  of  the  fetlock  joint,  and  consists  in  the  subcutaneous  section 
of  the  tendons  of  the  flexor  of  the  phalanges. 

In  this  affection  of  knuclding,  which  is  mostly  peculiar  to 
sohpeds,  there  is  lameness  more  or  less  marked,  with  a  hard  and 
painful  enlargem.ent  of  the  tendons,  and  a  consequent  interference 
with  the  act  of  locomotion,  caused  by  an  incomplete  flexion  of  the 
articulations.  The  fetlock  is  carried  forward,  and  contact  with  the 
ground  is  effected  with  the  toe  alone. 

Instances  of  spontaneous  ciu-e  or  abatement  are  exceedingly 
rare.  On  the  contrary,  it  has  a  tendency  to  aggravation,  the  swell- 
ing increasing,  and  the  deformity  becoming  by  degrees  more  and 
more  developed,  until  at  length  the  anterior  face  of  the  wall  of  the 
foot  rests  on  the  ground,  and  the  case  assumes  all  the  well  estab- 


0PEKATIOX8    UPON    FIBROUS    TISSUES.  313 

lished  characters  of  a  recognized  club-foot.  lu  a  majority  of  cases 
the  disease  is  localized  in  the  tendon  of  the  deep  flexor  of  the 
phalanges,  but  it  often  extends  to  the  superficial  tendon  as  well, 
or  may  involve  the  tarsal  or  carpal  baud,  or  the  suspensory  ligament. 

This  deformity  of  knuckling  may  exist  in  three  different  degrees : 
either  the  cannon  bone  and  the  phalanges  meet  in  an  almost  ver- 
tical hue,  as  in  the  case  of  the  animal  stra'ujht  or  xiprifjht  on  his 
paster )is,  which  is  the  first  degree;  or  the  bones  meet  to  form  an 
angle  opening  backward,  the  phalanges  being  somewhat  obhque 
ill  that  du-ection,  instead  of  forward,  as  in  the  normal  state,  and  the 
animal  still  resting  on  the  entire  plantar  surface  of  the  foot,  which 
is  the  second  degree ;  while  in  the  third  degree  these  conditions  are 
stni  more  exaggerated,  the  animal  traveling  altogether  on  his  toe  and 
exhibiting  a  case  of  the  perfect  talipes.  This  last  conformation, 
which  exists  principally  in  the  hind  legs,  is  specially  due  to  the 
retraction  of  the  deep  flexor,  while  in  the  other  degrees  it  is  the 
superficial  flexor  which  is  diseased.  Lesion  of  the  suspensory 
ligament  may  coexist  in  either  case. 

The  condition  of  the  tendons,  from  which  this  deformity  arises, 
is  not  the  only  question  to  take  into  consideration  when  the  pro- 
priety of  the  operation  is  to  be  determined.  The  causes  which 
have  produced  it  must  not  be  overlooked.  For  example,  while  ia 
the  hind  legs  the  accident  has  usually  a  traumatic  cause,  such  as 
a  sprain,  violent  over-exertion,  lacerations,  or  contusion  of  tendons ; 
when  the  fore  legs  are  affected  it  is  most  commonly  as  the  accom- 
paniment of  some  lesion  in  other  parts  of  the  leg,  as  of  the  foot 
or  the  digital  region  proper,  such  as  bad  feet,  na\dciilar  disease, 
contraction  of  the  heels,  corns,  quarter  and  toe-cracks,  quittors, 
deep  punctui-ed  wounds,  and  very  commonly  ringbones,  or  other 
exostoses. 

Taking  aU  these  various  causes  into  consideration,  with  their 
specific  natures,  and  the  extent  of  the  lesions  which  accompany 
them,  we  are  justified  in  belie\dng  vnih.  Gourd  on,  that  plantar 
tenotomy  is  indicated  with  fair  chance  of  success,  when  the  knuck- 
ling results  from  traumatism,  and  the  perforans  tendon  is  alone 
diseased ;  and  even  when  both  tendons  are  affected,  good  results 
are  still  not  improbable ;  but  that  it  is  contra-indicated  whenever 
complications  exist  which  are  likely  to  prevent  the  leg  from  re- 
turning to  its  natural  position,  as  when  the  disease  is  of  long 
standing ;  when  thei-e  are  alterations  of  the  articular  surfaces ; 


314 


OPEEATIONS    ON    MUSCLES    AND    THEIR    ANNEXES. 


anchylosis  of  the  fetlock ;  exostoses ;  adhesions  between  the  ten- 
dons and  the  bones ;  large  engorgements  of  the  tendinous  struc- 
ture ;  or  chronic  dilatation  of  the  synovial  bursse  sm-rounding  the 
region  of  the  fetlock.  Remediable  cases  would  seem,  from  this,  to 
constitute  rather  a  small  minority  of  the  whole  number. 

The  fibrous  tissues  acted  upon  in  plantar  tenotomy,  are  the 
tendons  of  the  flexors  of  the  phalanges,  in  that  part  of  their  length 
which  is  situated  back  of  the  cannon  bone,  between  the  carpal  or 
tarsal  sheath  and  the  fetlock.  The  superficial  tendon  reaching  the 
fetlock  forms  a  ring  through  which  the  deep  flexor  passes,  a  cir- 
cumstance from  which  has  been  devised  the  manner  of  perforatus 
and perforans,  by  which  they  are  known. 


Fig.  328.— Median  section  at  tbe  infe- 
rior row  of  the  carpus— of  the  metacar- 
pus and  suspensory  ligament. 

1.  Os  magnum. 

2.  Posterior  common  ligament  of  the 
carpus. 

3.  Band  to  the  perforans. 

4.  Suspensory  ligament. 

5.  Its  superficial  layer. 

6.  The  deep. 

7.  Principal  metacarpal  bone. 


The  superficial  tendon  is  covered  by  the  fibrous  expansion  of 
the  two  carpal  and  metacarpo-phalangeal  sheaths  in  the  fore,  and 
by  the  tarsal  and  metatarso-phalangeal  in  the  hind  leg.  The  deep 
flexor  toward  the  middle  of  the  cannon  receives  a  strong,  fibrous 
band  coming  from  the  posterior  ligament  of  the  carpus  or  tarsus. 
Below  and  between  the  two  small  metacarpal  or  metatarsal  bones 
is  the  suspensory  ligament,  a  strong  band,  thin  suj)eriorly  at  its 
origin,  and  bifid  inferiorly.  Between  the  suspensory  ligament  and 
the  cannon  bone,  there  is  an  interosseous  vein  and  the  two  inter- 
osseous arteries ;  on  the  side  of  the  tendons,  the  internal  and  ex- 
ternal collateral  veins,  with,  in  the  fore  leg,  the  principal  artery 


OPERATIONS    UPON    FIBROUS    TISSUES.  315 

collateral  of  the  cannon,  and  the  internal  plantar  nerve  as  its 
satellite  on  the  inside,  and  the  external  plantar  nerve  on  the  out- 
side of  the  leg;  while  on  the  posterior  leg  the  princijyal  artery  of 
the  cannon,  which  is  the  collateral  metatarsal,  is  situated  on  the 
outside  of  the  bone,  and  comes  in  relation  with  the  tendons  only 
in  the  lower  part  of  the  metatarsus. 

In  the  anterior  legs,  the  carpal  bursa,  hned  with  its  synovial 
sac,  extends  downward  on  the  flexor  tendons  as  far  as  below  the 
superior  third  of  the  metacarpal  region  ;  the  synovial  vaginal  sac 
of  the  sesamoid  sheath  runs  upward  along  the  tendons,  as  far  as 
the  lower  extremities  of  the  small  metacarpal  bones.  It  is  at  about 
the  center  of  the  middle  third  of  the  cannon  that  the  operation 
can  be  performed  without  fear  of  injuring  either  of  these  synovial 
sacs. 

In  the  hind  legs  the  tarsal  sheath  extends  as  far  as  the  upper 
part  of  the  middle  thii'd  of  the  metatarsal  region,  and  the  sesamoid 
sac  being  the  same  as  in  the  anterior  leg,  a  little  larger  space  is 
left  for  the  operation. 

Modus  Operandi. — To  perform  plantar  tenotomy,  the  animal 
must  be  thrown.  Some  practitioners  operate  with  the  horse  on 
his  feet,  but  this  position  is  dangerous,  although  by  the  use  of 
cocaine,  much  of  the  risk  attending  it  may  be  obviated.  The 
animal  is  thrown  on  either  side,  according  to  the  leg  upon  which 
the  operation  is  to  be  performed.  If  on  the  fore  leg,  it  must  be 
on  the  side  of  the  leg  to  be  operated  on  in  order  to  expose  the 
inside  of  the  limb ;  if  on  the  hind  leg,  the  animal  should  be  thrown 
in  such  a  manner  as  to  make  the  leg  upon  which  the  operation  is 
to  take  place  the  upper  one.  The  arrangement,  according  to 
Gourdon,  makes  the  operation  feasible  both  on  the  inside  of  the 
fore,  and  the  outside  of  the  hind  leg. 

Several  modes  of  proceeding  have  been  practiced.  The  old 
method  is  by  a  large  lateral  incision,  in  which  the  tendon  is  ex- 
posed, divided  either  with  a  bistoury,  or  by  being  raised  from  the 
wound  and  then  divided.  But  this  style  of  procedure  necessitates 
the  formation  of  large  wounds,  and  is  Hable  to  severe  and  trouble- 
some complications,  which  the  modern  or  subcutaneous  method 
ob^^ates. 

In  performing  the  subcutaneous  division,  two  instruments  are 
necessary.  These  are  the  straight  and  curved  tenotomes.  The 
blade  of  the  former  is  narrow,  straight,  thin  and  pointed ;  that  of 


316  OPERATIONS    ON    MUSCLES    AND    THEIR    ANNEXES. 


Fig.  329.- Straight  Tenotomy  Knife. 


Fig.  330.— Curved  Tenotomy  Knife. 

the  latter  narrow,  curved  and  blunt,  and  sharp  on  its    concave 
edge. 

The  ammal  being  prepared,  a  puncture  of  the  skin  is  made  over 
the  tendinous  region  (carefully  avoiding  the  synovial  sacs,  as  men- 
tioned above),  by  introducing  the  straight  tenotome  perpendicu- 
larly between  the  tendons,  until  the  point  of  the  instrument  is  felt 
on  the  opposite  side  of  the  leg.  A  slight  sawing  motion  of  the 
instrument  then  cuts  through  the  connective  tissue  which  unites 
them,  and  permits  the  introduction  of  the  cui'ved  tenotome  into 
the  tract  made  by  the  straight  instrument,  and  the  latter  is  slowly 
withdrawn.  At  this  point  the  leg  is  carried  into  excessive  exten- 
sion by  the  assistants,  by  means  of  ropes  secured  resiDectively, 
one  about  the  knee,  and  one  about  the  foot,  and  pulling  that  of  the 
knee  backward  and  that  of  the  foot  forward.  The  fetlock  being 
thus  stretched  to  its  utmost,  the  oj)erator,  with  the  edge  of  the 
curved  tenotome  turned  toward  the  deep  flexor,  makes  a  slight 
sawing  motion  with  the  instrument,  and  cuts  through  the  fibrous 
structure  from  behind  and  forward,  a  peculiar  crackling  sound  in- 
dicating when  the  sectionis  accomplished.  The  retracted  extrem- 
ities of  the  tendons  can  now  be  felt  with  a  wide  interval  between 
them,  and  the  straightening,  more  or  less,  of  the  fetlock  gives  fur- 
ther proof  that  the  operation  is  completed. 

This  is  the  method  in  simple  tenotomy.  Some  operators  have 
suggested  the  introduction  of  the  instrument  between  the  sus- 
pensory ligaments  aijd  the  perf orans  in  preference  to  the  mode  we 
have  described,  in  which  case  the  section  of  the  tendon  must  be 
made  from  before  backward.  It  is,  however,  a  complicated  pro- 
cess, and  one  which  is  not  without  danger  of  injuring  tissues 
which  ought  to  be  left  intact.  The  mode  of  ojDerating  known  as 
the  Bernard  method  is  based  on  this  principle. 

The  double  tenotomy,  though   considered  at  first  as  a  severe 


OPEKATIOXS    UPON    FIBEOTJS    TISSUES.  317 

operation,  does  not  involve  as  many  objections  as  at  first  thought, 
but,  on  the  contrary,  has  often  been  followed  by  very  satisfactory 
resiilts.  It  is,  therefore,  a  justifiable  operation  when  the  defor- 
mity of  the  fetlock  is  quite  extensive.  In  fact,  it  is  unavoidable 
when  both  tendons  are  united,  or  when  the  deviation  in  the  di- 
rection of  the  bony  levers  is  caused  equally  by  the  common  con- 
traction of  both.  In  performing  this  double  tenotomy,  the  divis- 
ion of  the  deep  flexor  being  made  by  the  manipulations  already 
described,  the  curved  tenotome  being  still  retained  in  the  wound 
between  the  tendons,  the  oj^erator  simply  reverses  its  position  in 
order  to  bring  the  cutting  edge  in  contact  with  the  superficial 
tendon,  and  completes  the  operation  precisely  as  already  described. 
In  this  division  of  the  tendon  great  caution  must  be  observed,  in 
order  to  avoid  making  a  complete  transverse  section  of  the  skin. 
Double  tenotomy  is  also  performed  in  some  cases  by  introducing 
the  tenotome  between  the  sus23ensory  ligament  and  the  tendons, 
and  dividing  them  by  a  section  made  at  once  through  both  from 
before  backward. 

In  some  peculiar  cases,  besides  the  division  of  the  two  tendons, 
that  of  the  suspensory  ligament  has  also  been  included,  sometimes 
in  connection  with  the  tenotomy,  and  sometimes  independently. 
In  this  case,  the  place  selected  difl^ers  from  that  which  is  indicated 
for  the  simj)le  or  double  oj^eration.  It  is.  indeed,  toward  the  lower 
extremity  near  the  bifurcation,  and  toward  the  lower  third  of  the 
cannon,  where  it  is  more  readily  reached.  The  straight  tenotome 
is  first  introduced,  flatwise  on  either  the  internal  or  external  face 
of  the  leg,  between  the  ligament  and  the  deep  flexor  of  the  pha- 
langes, carefully  avoiding  the  blood  vessels  and  nerves,  and  the 
curved  instrument  is  inserted  with  its  cutting  edge  toward  the 
ligament,  the  section  being  niade  by  cutting  from  behind  forward. 
The  instrument  must  not  be  introduced  between  the  bone  and 
the  hgament,  nor  must  the  section  be  made  from  before  back- 
ward ;  such  a  course  not  only  endangering  the  nerves  and  blood 
vessels,  but  also  involving  the  risk  of  breaking  the  blade  of  the 
tenotome  at  the  bottom  of  the  wound. 

"Whatever  mode  may  have  been  followed,  and  however  many 
tendons  may  have  been  divided,  or  whatever  force  may  have  been 
appHed  to  the  rope  by  the  assistants  who  made  the  traction,  it  is 
an  exceedingly  rare  result  to  obtain  a  perfect  straightening  of  the 
leg,  most  especially  when  the  disease  has  been  of  long  continu- 


318  OPERATIONS    ON    MUSCLES    AND    THEIR    ANNEXES. 

ance,  and  chronic  adhesions  may  exist.  A  short  walking  exercise 
following  the  operation  may  facilitate  the  straightening  of  the  leg, 
and  in  any  event  can  have  no  injurious  effect.  But  even  with  this, 
it  is  sometimes  several  days  before  any  well-marked  improvement 
can  be  discerned.  There  are  cases,  indeed,  when  ten  or  fifteen 
days  may  pass  without  noticeable  change,  but  if  it  fails  to  appear 
after  such  a  lapse  of  time,  the  case  may  be  considered  hopeless. 

There   are   practitioners,  however,  among  whom  are  Didot, 

Delward  and  Hering,  who  object  to  this  exercise,  and  hold  that 

the  natural  and  spontaneous 

straightening    of    the    fetlock 

can    be    greatly   assisted    by 

proper  shoeing,  as,  for  exam-  Fig.  332.— Mov- 

ple,  by  wearing  a  shoe  with  a  ^'^i"  Toe-Cork. 

Fig.  331.  —  Shoe  with  Pro-  long  toe,  such  as  are  used  in  cases  of  club- 

longed  Toe.  for  ciub-Foot.       f^^^^  ^^  ^„^:^^  ^^,  having  pecuUar  movable 

toe-corks  by  which  the  effect  of  the  bearing  of  the  shoe  is  in- 
creased. The  ordinary  long-toed  shoe  represented  in  Fig.  333 
is  often  worn  with  advantage. 


Long-Toe  Shoe. 


Complete  rest  after  the  operation  will  benefit  the  patient  in  the 
most  essential  manner  by  diminishing  the  causes  of  pain  and  favor- 
ing the  cicatrization,  and  possibly  preventing  an  exaggerated  ex- 
tension at  the  fetlock.  It  is  only  after  from  twenty  to  twenty-five 
days  that  moderate  exercise  may  be  allowed,  and  not  less  than  six 


OPERATIONS    UPON    FIBROUS    TISSUES. 


319 


weeks  should  elapse  before  the  ordinary  labor  of  the  patient  can 
be  resumed.  The  resulting  wound  needs  no  special  dressing,  and 
by  being  thoroughly  sterihzed  by  antiseptic  manipulations,  the 
jmrts  will  heal  without  trouble.  The  suggestions  of  poultices, 
fomentations,  counter  iriitation,  blisters  and  firiag  of  old-time 
surgery  must  be  sti-ictly  ignored. 

If,  however,  all  the  measures  recommended  for  the  straighten- 
ing of  the  leg  should  fail,  and,  on  the  contrary,  a  tendency  to  an 


Pig.  334.  Fig.  335. 

Figs.  33t,  335,  336.— "Various  Apparatus  Recommended  after  Tenotomy. 

excessive  extension  of  the  fetlock  should  be  manifested,  the  apj)li- 
cation  of  some  of  the  various  kinds  of  aj^paratus  designed  for  the 
correction  of  these  defects  may  be  experimentally  tried,  with  a 


320 


OPERATIONS    ON    MUSCLES    AND    THEIR    ANNEXES. 


possibility  of  good  results.  According  to 
their  peculiar  working  arrangements,  slowly 
increased  extension  might  be  maintained' 
or  the  leg  might  be-  steadily  retained  in  a 
given  position,  or  with  the  power  of  regu- 
lated motion,  the  result  being  an  important 
and  permanent  imjjrovement  in  the  value 
and  comfort  of  the  animal. 

The  accidents  which  may  be  apprehend- 
ed in  connection  with  plantar  tenotomy  are 
hemorrhage  and  loounds  of  nerves,  or  of 
the  skin,  or  of  the  synovial  sacs  ;  an  exag- 
geration of  the  extension,  and  a  return  of 
the  original  deformity.  To  these  Peuch 
and  Toussaint  add  gangrene. 

(a)  Hemorrhage,  both  arterial  or  vein- 
FiG.  336.  Q^^g      -Q^^  ^iiis  may  be  avoided  by  careful 

attention  to  the  rules  laid  down  for  the  operation,  and  if  it  should 
occur,  hemostatis  by  pressure  must  be  resorted  to,  and  the  band- 
age can  be  safely  removed,  or  at  least  the  jDressure  diminished,  in 
from  twelve  to  twenty-four  hours. 

(b)  Wounds  of  JVerves. — These  cannot  very  well  be  avoided, 
and  while  they  are  manifested  by  severe  struggles  of  the  animal 
at  the  moment  of  their  occurrence,  they  involve  no  dangei'  other 
than  those  pertaining  to  similar  injuries  in  other  regions,  \dz.:  the 
temj)orary  suspension  of  the  sensorial  functions. 

(c)  Wounds  of  the  Skin. — These  are  among  the  comparatively 
severe  complications,  and  when  they  occur,  they  destroy  all  the 
advantages  which  properly  accompany  the  operation  as  a  subcu- 
taneous process.  They  are  likely  to  complicate  the  operation  with 
fungoid  growths  uj)on  the  stumps  of  the  tendons,  abundant  sujv 
pui-ation,  ugly  cicatrices,  etc.,  and  should  therefore  be  specially 
guarded  against. 

(d)  Wounds  of  the  Tendinous  JBursm. — These  may  be  attrib- 
uted to  an  improper  selection  of  the  place  where  the  punctui-e 
should  be  made,  and  may  be  recognized  by  the  flow  of  synovial 
fluid  from  the  wound.  Suppurative  synovitis  may  then  complicate 
the  case  with  fatal  effect.  The  treatment  they  require  is  that 
directed  for  oj)en  synovial  tumors.  Local  applications,  rest,  pres  ■ 
sure,  counter  irritation,  blisters  and  firing  are  the  indications. 


OPERATIONS    UPON    FIBROUS    TISSUES.  321 

(e)  Exaggeration  of  the  Extension. — This  may  take  place 
^hen  artificial  means  to  produce  sudden  extension  are  too  power- 
ful, or  when  the  %iolent  efforts  of  the  animal  have  caused  a  ten- 
dency in  the  parts  to  give  way  suddenly.  The  apparatus  before 
referred  to  must  be  here  brought  into  requisition. 

(/)  Return  of  the  Original  Deformity. — This  results  from 
the  retraction  of  the  new  tissue  formed  between  the  stumps  of 
the  divided  tendon.  It  occurs  as  a  consequence  of  returning  the 
animal  to  his  work  at  too  early  a  date,  and  when  the  newly  formed 
tissvie  has  not  yet  become  sufficiently  matured  and  sohdified  to 
sustain  the  strain  to  which  it  had  been  subjected.  Best,  cold 
water  bathing  in  a  running  stream,  vesicating  applications  and 
firing  have  been  recommended  as  remedies,  and  even  a  second 
section  of  the  tendon  may  be  suggested,  though  with  but  a  doubt- 
ful prospect  of  good  results. 

Carpal  Tenotomy. 

This  defines  the  section  of  the  tendons  of  the  external  and 
oblique  flexor  muscles  of  the  metacarpus.  They  are  inserted  on 
the  trapezium  bone  of  the  carpus,  and  their  retraction  occasions 
the  deformity  known  as  sprung  knees,  a  condition  brought  on  by 
excessive  and  exhaustive  labor,  though  there  is  a  class  of  pa- 
tients in  which  the  lesion  may  be  ascribed  to  a  congenital  taint, 
and  it  is  principally  for  the  benefit  of  this  class  of  patients  that 
the  operation  is  indicated  and  usually  performed.  It  is  principally 
favored  and  utilized  in  Germany,  where  it  was  originated  hj 
Dieterichs,  though  afterwards  adopted  and  practiced  by  Prud- 
homme,  Lafosse,  Miguel,  Brogniez,  Hering,  Gourdon  and  others. 
The  operation  can  be  performed  on  either  tendon  singly,  or  on 
both  ;  but  according  to  Hering,  the  division  of  the  external  mus- 
cle is  generally  sirfficient. 

The  anatomy  of  the  region  should  be  described  before  passing 
to  a  detail  of  the  steps  by  which  the  section  of  the  tendon  is  ef- 
fected. The  external  flexor  is  situated  on  the  postei-ior  external 
part  of  the  forearm,  and  terminates  by  the  branches,  one  of  which, 
the  funicular,  is  anterior,  and  passing  in  the  groove  of  the  external 
face  of  the  trapezium,  becomes  attached  to  the  hand  of  the  exter- 
nal rudimentary  metacarpal  bone ;  while  the  other  posterior,  wide 
and  short,  goes  to  the  supero  and  posterior  circumference  of  the 
same  bone,  in  connection  with  the  middle  flexor,  to  which  it  is 


322 


OPERATIONS    ON    MUSCLES    AND    THEIR    ANNEXES. 


united.  The  section  must  be  made  above  tlie  bifurcation  of 
the  tendon,  to  avoid  the  artery  which  passes  under  it,  though 
it  is  quite  deeply  situated,  and  besides,  there  is  no  danger 
of  injuring  the  synovial  sac  of  the  carpal  arch.  The  obhque 
flexor  is  situated  back  and  inside  of  this,  and  has  its  tendon  single, 
terminated  on  the  trapezium,  with  the  posterior  tendon  of  the 
external  flexor.  The  section  must  be  made  before  the  union  of 
the  two  tendons,  in  order  to  avoid  injury  to  the  carpal  arch. 

The  animal  is  thrown,  and  the  knee  extended  with  two  ropes, 
one  above  and  one  below  the  knee,  and  drawn  in  opposite  direc- 
tions. The  same  instruments  are  used  for  carpal  as  for  plantar 
tenotomy. 

The  incision  of  the  skin  is  made  about  two  inches  above  the  knee 
with  the  straight  tenotome,  immediately  in  front  of  the  tendon, 
which  is  easily  felt  under  the  skin,  and  is  raised  with  the  fingers ; 
the  curved  tenotome  is  inserted  between  the  skin  and  the  tendon, 
from  before  backward,  and  the  section  made  as  in  the  plantar 
operation.  Gourdon  suggests  the  introduction  of  the  knives 
under  the  tendon  instead  of  between  that  and  the  skin.  By  this 
mode  the  di\ision  is  made  from  within  outward,  while  in  the 
other  way  it  is  made  from  without  inward. 

The  external  flexor  being  thus  divided,  the  section  of  the 
middle  flexor  is  made  a  little  below ;  the  puncture  of  the  straight 
tenotome  is  made  between  the  two  tendons,  and  the  cui'ved 
tenotome  inserted  as  before,  between  the  skin  and  the  tendon 
from  before  backward,  or  preferably,  from  without  inward,  and 
when  its  blunt  end  is  felt  on  the  posterior  border  of  the  muscle, 
the  section  is  made  from  without  inward,  with  the  usual  motion  of 
the  knife.  Only  a  simple  dressing  is  required,  but  the  animal 
must  be  kept  at  rest  for  at  least  a  month. 

The  modus  operandi  to  which  we  give  the  preference  over  that 
which  we  have  just  narrated,  and  which  we  have  described  in  our 
work  on  lameness,  is  very  simple.  The  animal  being  thrown,  on 
the  side  opposite  to  that  of  the  operation,  and  the  knee  extended 
as  usual,  the  operator,  who  is  in  front  of  the  knee,  feels  for  the 
space  between  the  two  muscles,  where  they  are  about  to  unite, 
and  this  being  found,  a  straight  tenotome  is  introduced  through 
the  skin  from  before  backward,  about  two  inches  above  the  super- 
ior border  of  the  trapezium,  and  under  the  thickness  of  the 
middle  flexor,  and  when  the  point  of  the  instrument  is  felt  on  the 


OPERATIONS    UPON    FIBROUS    TISSUES.  323 

other  border  of  the  muscle,  in  front,  the  curved  tenotome  is  in- 
serted and  the  straight  one  withdrawn,  and  the  tendon  divided 
from  within  outward ;  the  straight  tenotome  is  then  re-introduced 
through  the  same  opening,  between  the  muscles,  and  carried  from 
behind  forward  on  the  posterior  border  of  the  external  flexor, 
imder  its  thickness,  tmtil  the  point  of  the  instrument  is  felt  on 
the  anterior  border,  when  the  curved  tenotome  is  again  re-insert- 
ed, and  the  division  of  the  tendons  performed  as  before.  The 
wound  of  this  ojseration  is  simple,  heals  readily,  and  is  Hable  to 
no  complications  or  accidents.  Of  course  the  operator  must  ex- 
ercise due  caution,  when  dividing  the  tendons  from  within  out- 
ward, to  avoid  making  a  complete  section  through  the  skin. 

Anti-Brachial   Tenotomy. 

This  operation  has  been  recommended  for  the  relief  resijec- 
tively  of  sprung  knees  and  knuckled  fetlocks,  but  by  reason  of  the 
numerous  and  almost  constant  failures  by  which  it  was  character- 
ized, has  been  discredited,  and  banished  from  the  domain  of  our 
surgery.  It  consisted  in  the  section  of  the  tendinous  band  which 
from  the  lower  extremity  of  the  coraco-radialis  extends  downward 
to  mingle  with  the  fibres  of  the  anti-brachial  aponeurosis,  in  pass- 
ing a  httle  below  and  in  front  of  the  elbow  joint. 

Brogniez,  who  recommended  the  operation,  performed  it  by 
making  a  longitudinal  incision  of  the  skin  over  the  course  of  the 
tendon,  which  is  readily  felt  under  the  skin,  and  passing  the  point 
of  a  convex  bistoury  over  the  aponeurosis  and  the  band,  dividing 
it  from  without  inward. 

Tarsal   Tenotomies. 

Two  modes  of  operation  are  practised  uj)on  some  of  the 
tendons  surrounding  the  hock  joints,  one  upon  the  cunean  branch 
of  the  flexor  metatarsi  muscle,  the  other  upon  the  tendons  of  the 
lateral  extensor  of  the  phalanges.  They  are  known  distinctively 
as  the  cunean  and  the  jyeroneo-phalangeal  tenotomy. 

(«. )  Cunean  Tenotomy.  —  The  flexor  metatarsi,  one  of  the 
muscles  of  the  anterior  tibial  region,  is  composed  of  two  por- 
tions, one  muscular,  the  other  tendinous.  The  tendinous  portion 
is  situated  between  the  muscular  portion  and  the  anterior  extensor 
of  the  f)halanges,  and  is  attached  above  to  the  inferior  extremity 
of  the  femur,  between  the  external    condyle    and  the    external 


324 


OPERATIONS    ON    MUSCLES    AND    THEIR    ANNEXES. 


border  of  tlie  trochlea  of  that  bone,  and  passes  in  the  groove 
situated  between  the  anterior  and  external  tuberosity  of  the 
superior  extremity  of  the  tibia,  do^vTiward  to  the  hock,  where  it 
rests  on  the  anterior  face  of  that  joint  and  is  attached  by  two 
branches,  one  to  the  cuboid,  on  the  outside  of  the  hock,  the  other 
to  the  superior  extremity  of  the  principal  metatarsal  bone.  The 
muscular  portion,  which  rests  on  the  external  face  of  the  tibia, 
from  the  upper  part  of  which  it  takes  its  origin,  terminates  in- 
feriorly  by  a  tendon  which  passes  through  a  ring  of  the  tendinous 
portion,  and  becomes  more  superficial,  and  then  divides  into  two 
branches,  a  large  one,  which  goes  to  the  superior  part  of  the 
princii^al  metatarsal  bone,  in  uniting  with  that  of  the  tendinous 
portion,  and  another,  smaller,  which  bends  inward,  to  terminate 
at  the  small  cuneiform  bone.  This  branch  is  chosen  as  the  seat 
of  operation. 

The  operation  recommended  by  Abildgaard  and  Viborg,  was 
indicated  by  Hertwig,  and  at  a  later  period  performed  by  Lafosse, 
Hering,  Mantel,  Grad,  Bugniet  and  Dieckerhoff.  It  is  very  com- 
monly performed  on  this  continent,  and, 
like  many  other  operations  at  the  time 
of  their  first  introduction,  has  been  both 
used  and  probably  abused  to  such  an  ex- 
tent that  it  has  not  yet  received  the  credit 
to  which  it  is  fairly  entitled. 

It  is  indicated  for  the  relief  of  the  pres- 
sure which  this  branch  makes  upon  the 
distended  periosteum  of  the  enlarged  tar- 
sal exostoses  known  as  s^^avins,  and  when 
the  exostosis  is,  strictly  speaking,  the  only 
lesion  in  the  hock,  it  will  prove  essen- 
tially beneficial.  But  if,  with  the  new 
growth  of  bony  deposits,  the  joint  itself 
Fig.  337.— cunean  Branch  of  the  should  be  involved,  and  some  of  the  ar- 

Flexor  Metatarsi.  ^.^^^^^^.  ^gg^ggg    gj^Q^^j^j   ^^   present,  the 

result,  so  far  as  the  removal  of  pain  and  lameness  is  concerned, 
is  not  always  certain.  Although  more  or  less  satisfactory  at  times, 
in  many  instances  it  entirely  fails.  The  difficulty  of  positively 
diagnosing  the  condition  of  the  articular  surfaces  justifies  the 
surgeon  in  operating,  when  the  tense  condition  of  the  tendon,  its 
pressure  upon  the  exostosis,  and  the  irritation  of  the  synovial  sac 


OPEKATIONS    UPON    FIBROUS    TISSUES. 


325 


"which  aids  its  raovements,  which  it  produces,  poiut  with  certainty 
to  the  cause  of  the  lameness. 

The  instruments  necessary  are  scissors,  a  straight  and  a  con- 
vex bistoury,  a  dissecting  forceps,  a  curved  director,  and  pei-haps 
a  curved  tenotomy  knife. 

The  animal  is  cast  on  the  side  of  the  leg  to  be  operated  upon, 
the  upper  leg  carried  forward  and  secured  on  the  upper  forearm, 
and  the  hair  cUpped  over  the  tract  of  the  tendon,  which  can  be 
readily  identified  by  an  oblique  groove  generally  found  running 
on  the  upper  portion  of  the  bony  enlargement.  An  incision 
about  two  and  a  half  inches  long  is  made  with  the  convex  bis- 
toury, either  j)arallel  to  the  tendon,  or  slightly  obhque,  and  right 


Fig.  338.— Tarsal  Tenotomy.    Cunean 
Tendon  Exposed. 


Fig.  339.— Tarsal  Tenotomy.    Tbe 
Tendon  Raised. 


across  its  direction.  This  incision  is  generally  accompanied  by  a 
somewhat  troublesome  capillary  hemorrhage,  which  ought  to  be 
controlled  before  proceeding  furthei\  The  tendon  may  then  be 
felt  through  its  bursa,  which  is  raised  with  the  dissecting  forceps 
and  opened,  when  the  tendon  is  readily  exposed.  The  curved 
director  is  then  inserted  under  the  tendon,  which  is  easily  raised 
from  its  tract,  and  by  guidiug  the  tenotome  along  its  groove  the 
section  is  made  by  a  single  stroke. 

Some  practitioners  complete  the  operation  by  amputating  a 
portion  of  the  tendon.  This  is  unnecessary,  and  complicates  the 
operation  by  subjecting  the  parts  to  the  necessity  of  a  repairing 


326  OPERATIONS    ON    MUSCLES    AND    THEIR    ANNEXES. 

process,  which  is  not  needed  for  the  result  of  the  operation,  and 
exposes  the  animal  to  a  complication  of  inflammation  of  the 
synovial  bursae  which  ought  to  be  avoided.  To  obviate  these 
dangers,  Dieckerhoff  is  of  the  opinion  that  the  division  of  the 
bursa  is  all  that  is  required,  and  states  that  he  has  often  secured 
good  results,  from  that  alone,  without  the  section  of  the  tendon. 
Besides  this  mode  of  operating,  which  may  be  called  the  02)en 
incision,  there  is  another  procedure  by  subcutaneous  division, 
which  is  also  recommended  by  some,  but  the  difficulty  of  discover- 
ing the  tendon  in  its  bony  groove,  and  in  reaching  it  properly,  and 
the  possible  complication  of  subsequent  inflammation  of  the  bursse, 
will  probably  secure  the  preference  for  the  method  by  open  incis- 
ion. The  operation  is  completed  by  closing  the  wound  with  a 
stitch  of  suture,  and  protecting  it  with  antiseptic  dressings.  The 
results  of  the  operation  are  sometimes  immediate,  though  in  some 
cases  not  apparent  for  a  few  days,  but  if  after  the  lapse  of  two  or 
three  weeks  the  lameness  has  not  either  disappeared  or  greatly 
abated,  it  may  be  safely  concluded  that  it  is  attributable  to  some 
cause  other  than  the  pressure  of  the  tendon. 

{b.)  Peroneo- Phalangeal  Tenotomy.  —  Though  the  true 
pathology  of  the  peculiar  afi'ection  of  the  hock  joint  known  as 
springhalt,  and  the  cause  that  excites  the  spasmodic  action 
characterizing  it,  are  far  from  being  satisfactorily  known,  it  has 
been  observed  that  in  animals  thus  afiected  the  tendons  of  the  ex- 
tensors of  the  foot  in  front  of  the  hock  have  a  tense  or  rigid 
character,  which  renders  them  unusually  prominent ;  and  it  is  this 
symptom  which  suggested  to  Brocar,  a  Belgian  veterinarian,  the 
division  of  the  tendon  of  the  lateral  extensor  of  the  phalanges,  or 
peroneo-phalangeal  muscle,  as  a  means  of  cure.  Brocar,  Brogniez, 
and  Delwart  performed  it,  and  have  recorded  their  success  in 
numerous  cases. 

The  lateral  extensor  of  the  phalanges  terminates  inferiorly  by  a 
round  tendon,  which  passes  into  the  groove  situated  on  the  out- 
side of  the  lower  extremity  of  the  tibia,  in  a  sheath  formed  at  the 
expense  of  the  superficial  external  ligament  of  the  tibio- tarsal 
joint.  In  this  sheath  it  bends  forward  and  downward  to  join  the 
tendon  of  the  anterior  extensor  toward  the  middle  of  the  metatar- 
sus, which  it  crosses  downward,  forward  and  inward. 

The  operation  is  of  the  simplest  nature,  and  may  be  j)erformed 
with  great  facility.     The  animal  being  cast,  and  the  section  com- 


OPERATIONS    UPON    FIBROUS    TISSUES.  327 

pleted  tlirough  a  small  incision  made  over  the  tendon,  a  little  be- 
low the  hock,  and  near  its  junction  with  the  principal  extensor, 
about  one  inch  of  the  tendon  is  removed.  Sometimes  the  action  of 
si^ringhalt  ceases  at  once,  when  the  animal  is  allowed  to  rise  to  his 
feet.  Other  cases  require  a  few  days  for  the  completion  of  the 
cure.  The  simple  operation  has  proved  satisfactory  in  our  hands 
in  two  cases. 

Tenotomy  in  Birds. 
The  operation  is  performed  in  this  instance  with  the  object  of 
preventing-  the  animals  from  flying,  and  consists  in  the  section  of 
the  tendons  of  the  extensor  muscles  of  the  carpus  and  phalanges. 
The  bird  is  held  by  an  assistant,  with  its  wing  extended,  and  a 
few  feathers  are  pulled  out  from  each  side  of  the  carpal  joint,  as 
well  as  in  front  of  the  radius,  to  expose  the  skin,  through  which 
the  extensor  tendons,  two  in  number,  are  readily  seen.  A  small 
incision  being  made  through  the  skin,  the  tendon  is  raised  with 
forceps,  and  a  portion  of  it  amputated,  the  operation  being  re- 
peated on  the  other  side  of  the  wing  upon  the  extensor  tendons 
of  the  digits,  between  the  radius  and  the  cubitus.  The  treatment 
is  applied  to  both  wings ;  it  is  without  hemorrhage,  and  the 
wounds  heal  in  two  or  three  days. 


CHAPTER  Vni. 

OPERATIONS  ON  THE  DIGESTIVE 
APPARATUS. 

ON  THE  TEETH. 

The  office  fulfilled  by  tlie  dental  system  in  the  preliminary 
preparation  of  the  ingesta,  and  the  first  step  in  the  process  of  di- 
gestion, is  necessarily  one  of  the  utmost  imj^ortance.  Of  course, 
therefore,  any  diseased  conditions  which  may  interfere  with  its 
efficient  action,  especially  with  the  herbivorous  animals,  become 
matters  of  deep  interest  to  the  veterinary  practitioner.  All  facts 
and  circumstances  concur  to  establish  and  substantiate  the  claims 
of  that  branch  of  veterinary  science  which  refers  to  the  care 
of  the  teeth  as  a  very  important  specialty,  and  we  shall,  there- 
fore, so  estimate  and  so  elucidate  the  subject  of  vetermary  dentis- 
try, so  successfully  studied  and  so  largely  developed  in  recent 
years  by  American  veterinarians. 

The  diseases  of  the  teeth  to  which  our  domestic  animals  are 
subject  may  be  due  to  various  pathological  conditions.  The  den- 
tal arches  formed  by  their  arrangement  in  the  jaw  may  be  the 
seat  of  congenital  deformity ;  the  teeth  may  possess  abnormal 
qualities  in  respect  to  their  number,  their  shape  and  their  direc- 
tion ;  or,  again,  in  the  condition  of  their  grinding  siirfaces,  and 
there  may  also  be  special  diseases  of  the  elementary  substances 
of  the  tooth  itself.* 

The  abnormahty  which  exists  in  relation  to  the  number  of  the 
teeth  is  of  not  vincommon  occurrence  in  horses,  in  which  animal  we 
sometimes  discover  the  j)resence  of  supplementary  molars,  resulting 
either  from  the  persistence  of  a  temj)orary  tooth  which  has  failed 
to  be  shed  at  the  proper  time,  or  may  be  due  to  an  excess  of  de- 
velopment in  the  evolution  of  a  dental  foUicle,  as  we  may  observe 
in  the  formation  of  the  v;olf  tooth. 

In  relation  to  the  shape  of  the  dental  arches,  there  are  cases 

»  We  take  pleasure  in  recommending,  in  connection  with  this  subject,  the  excellent 
little  work  on  Horses'  Teeth,  written  by  Mr.  William  H.  Clarke. 


OPERATIONS    ON    THE    TEETH. 


329 


where,  instead  of  presenting  the  regular  and  correct  natural  lines, 
the  upper  and  lower  molar  arches  so  far  disagree  as  to  render 
theu'  perfect  coaptation  impossible,  and  render  the  execution  of 
their  function  to  a  great  extent  impracticable.  The  direction  or 
implantation  of  the  teeth  is,  at  times,  so  far  irregular  and  abnor- 
mal as  to  change  the  frictional  surfaces  in  such  a  manner  as  to 
remove  the  wear  and  abrasion  from  the  crown  to  the  surface  of 
the  organ.  In  relation  to  the  disposition  of  their  rubbing  sur- 
faces, it  is  well  known  that'  on  account  of  the  difference  existing 
in  the  consistency  and  power  of  resistance,  two  of  their  elements, 
the  enamel  and  the  dentine,  their  frictional  surfaces  become  rough, 
irregular  and  sharp;  and,  as  they  sometimes  assume  excessive 
dimensions,  they  may  give  rise  to  serious  phenomena,  especially 
when  they  have  theu'  seat  in  a  part  of  the  dental  arch  where  no 
resistance  can  be  offered  to  their  development,  as  when  the  cor- 
responding tooth  of  the  opposite  jaws  becomes  diseased  or  absent. 

The  special  diseases  of  the  elementary  constituents  of  the  teeth 
exist  in  the  depth  of  their  substance,  and  consist  in  caries  or  ul- 
ceration of  the  tooth,  the  affection  involving  the  dental  pulp  itself, 
with  other  diseases  pertaining  to  the  alveolo-dental  rnembrarie,  all 
of  them  being  accompanied  by  a  series  of  well  understood  symjD- 
toms,  severely  distinctive  in  their  character,  and  which  in  the  ma- 
jority of  cases  call  for  the  assistance  of  the  veterinary  dentist  in 
order  to  reheve  the  suffering  animal  from  the  distress  in  which 
his  human  master  knows  but  too  well  how  to  sympathize. 

The  symptoms  pertaining  to  the  various  conditions  above  al- 
luded to  may  be  either  common,  or  general,  or  special.  Among 
the  general  symptoms,  the  first  to  be  observed  is  a  change  in  the 
style  of  performing  the  function  of  mastication,  proportional  to 
the  sensitiveness  occasioned  by  the  dental  lesion.  Thus  it  is  ob- 
served that  although  the  animal  seizes  his  food  with  the  same 
avidity  as  if  his  teeth  were  in  good  order,  the  motion  of  his  jaws, 
the  chewing  of  the  food,  are  slowly  and  carefully  performed,  the 
lateral  movements  of  the  lower  jaw  occurring  in  a  hesitating  man- 
ner, and  often  made  on  one  side  of  the  mouth  only.  In  eating 
hay,  the  mouthful  of  the  food  is  never  triturated  as  it  ought  to 
be,  and  before  the  process  of  mastication  is  completed  the  animal 
drops  it  out  of  its  mouth  in  the  shape  of  a  flattened  bolus,  satu- 
rated with  saliva,  to  seize  it  again  and  make  a  new  attempt  at 
mastication,  perhaps  twisting  his  jaw  in  different  directions  in  his 


330  OPERATIONS    ON    THE    DIGESTIVE    APPARATUS. 

endeavor  to  accomplisli  tlie  act  without  pain.  The  attempt  seems, 
however,  to  be  vain  ;  again  the  mouth  is  opened  and  the  same 
flattened  bolus  is  dropped  in  the  manger,  and  this  continues  untH 
the  poor  animal,  suffering  and  hungry,  is  seen  standing  before  a 
rack  full  of  hay  for  which  he  both  longs  and  fears  to  touch.  The 
suffering  horse  will  sometimes  swallow  his  oats  imjjerfectly  mas- 
ticated, but  the  partial  chewing  is  performed  slowly  and  with  dif- 
ficulty, his  manner  indicating  the  jDain  it  costs  him ;  dipping  his 
nose  in  the  manger,  chewing  on  the  grain  for  a  long  time,  and 
impregnating  it  with  saHva  before  he  swallows  it.  Soft  food,  bran 
and  mashes,  cooked  roots,  scalded  grains,  and  the  like,  are  the 
only  aliments  that  can,  without  difficulty  with  this  imperfect  de- 
gree of  mastication,  enter  into  the  phaiynx. 

Animals  suffering  with  diseases  of  the  dental  apparatus  are 
often  affected  with  coHcs.  At  first  they  may  be  slight  and  inter- 
mittent, but  they  soon  become  more  severe  and  more  frequent. 
They  may  last  for  several  days,  and  may  be  marked  by  the  pecu- 
liarity that  during  their  continuance  defecation  may  still  continue, 
though  irregular  as  to  time,  and  the  movements  scanty  in  amount, 
the  foeces  besides  being  in  small  and  adherent  lumps,  and  more 
or  less  coated.  In  other  cases  they  are  soft,  and  the  animal  has  a 
tendency  to  be  washy,  and  more  or  less  to  scour,  but  in  either 
case  the  droppings  are  more  or  less  loaded  with  unmasticated 
food.  All  these  symptoms  are  manifestations  resulting  from  an 
imperfect  digestion. 

It  is  easy  to  understand  that  if  this  condition  continues  for 
any  length  of  time  the  entire  economy  will  suffer  from  it.  The 
animal  looses  flesh ;  his  coat  becomes  dull,  dry  and  staring  ;  his 
force  and  ardor  diminish ;  he  sweats  easily,  and  all  his  other  func- 
tions exhibit  evidences  of  the  weak  condition  of  an  organism  de- 
prived of  the  nutrition  and  strength  which  foUow  the  ingestion  of 
food  thoroughly  masticated  and  well  digested. 

Having  recognized  these  symptoms,  which,  if  not  seen  by  the 
surgeon,  should  be  brought  to  his  attention  through  the  history 
of  the  patient;  when  intelhgently  stated,  the  diagnosis  may  be 
considered  established.  But  it  becomes  positive  only  after  an 
examination  of  the  mouth,  by  which  the  special  symjotoms  per- 
taining to  each  alteration  are  elicited. 

The  inspection  of  the  mouth,  which  may  be  kept  oj)en  by  the 
use  of  the  various  sjDeculums,  or  by  merely  pulling  the  tongue 


OPERATIONS  ON  THE  TEETH.  331 

sidewise  out  of  the  way,  will,  in  a  great  majority  of  cases,  easily 
lead  to  the  detection  of  the  cause  which  interferes  with  masti- 
cation. 

Fu^st  of  all,  when  the  mouth  is  opened,  a  peculiar  symptom 
wiU  be  observed,  consisting  in  a  change  in  the  salivary  secretion. 
This  will  be  increased  more  or  less,  and  as  the  saliva  will  escape 
freely,  a  pecuhar  acid  odor  will  be  noticed  j)roceeding  from  it,  and 
on  looking  for  the  cause  of  this  trouble,  if  it  be  one  or  other  of 
the  iri'egularities  already  mentioned,  such  as  the  projection  of  one 
of  the  teeth,  the  vicious  incHnation  of  their  crowns,  the  sharp 
edges,  etc.,  critical  inspection  will  soon  reveal  them.  The  teeth 
■will  be  found  to  be  soiled  with  greenish  food-detritus  on  the  side 
where  the  difficulty  exists,  and  on  that  same  side  the  animal  will 
be  found  to  have  stored  the  surplus  food  which  he  has  accumu- 
lated between  his  teeth  and  the  cheek. 

If,  however,  in  consequence  of  being  situated  so  far  back  in 
the  mouth  that  the  eye  fails  to  detect  the  condition  of  the  part, 
he  can  complete  his  examination  with  his  hands.  "With  due  prac- 
tice in  this  mode  of  investigation,  one  may  become  sufficiently 
expert  in  the  manipulation  of  the  mouth  to  dispense  entirely  with 
the  aid  of  the  speculum ;  though  of  course  there  will  be  cases 
when  in  order  to  establish  a  thorough  diagnosis  of  the  exact  and 
positive  condition  of  the  part,  this  instrument  cannot  be  dispensed 
with.  There  are  also  conditions  where  the  examination  cannot 
be  carried  out  in  the  standing  position,  even  with  the  assistance 
of  means  of  restraint,  and  the  animal  must  be  thrown  down,  and 
even,  says  Bouley,  "  placed  under  the  effects  of  ether.  In  this  condi- 
tion, the  jaws  are  readily  kept  open  and  immobile,  the  tongue  is  free 
from  contraction,  and  the  hands  and  fingers  can  be  carried  over 
the  entire  length  of  the  dental  arches  without  the  slighest  danger 
to  the  operator." 

Manual  exploration  removes  all  doubt  about  the  diagnosis, 
since  the  surgeon  may,  by  skillfully  j)racticing  the  taxis,  recognize 
all  the  UTegularities  present,  whether  the  vicious  direction  of  the 
dental  surfaces,  the  uneven  wearing  of  the  teeth,  the  cavities 
which  may  exist  in  their  thickness,  or  the  condition  of  their  im- 
plantation with  that  of  the  alveolar  cavity,  etc. 

When  the  mucous  membrane  has  been  excoriated  by  the  sharp 
projections  of  the  teeth,  when  the  gums  are  highly  inflamed,  and 
the  jawbones  have  been  bruised,  and  are  necrosed  and  suppurating; 


332  OPERATIONS    ON    THE    DIGESTIVE    APPARATUS. 

when  the  saHva  which  flows  from  the  mouth  is  abundant,  gluey 
and  foetid  in  odor ;  when  the  mouth  is  hot,  the  mucous  membrane 
injected,  and  in  the  regions  where  this  diffused  inflammation  has 
started,  lesions  are  aj^parent  corresponding  to  the  cause  that  pro- 
duced them,  such  as  deep  cuts  on  the  internal  face  of  the  cheeks, 
which  have  been  torn  by  the  asperities  of  the  teeth ;  when  there  is 
swelling  and  redness  of  the  gum  at  the  point  where  it  is  inflamed ; 
when  there  is  enlargement  of  the  bone,  with  a  grajdsh  hue  at  the 
point  where  it  is  exposed  and  in  process  of  sloughing ;  or  again  if 
these  fistulas  penetrating  the  spongy  tissues  of  the  maxillary  bone 
— all  this  becomes  evident  under  the  careful  and  accurate  manip- 
ulation of  the  instructed  fingers. 

Besides  the  exhibition  of  the  general  symptoms  belonging  to 
all  diseases  of  the  dental  apparatus,  caries  of  these  organs  is 
characterized  b}'  some  special  characters  belonging  to  them  ex- 
clusively. Principal  among  these  is  the  peculiar  foetor  of  the  in- 
terior of  the  mouth  and  of  the  saliva  flowing  from  it,  which  is 
sui  generis.  There  is  also  the  escape  from  the  mouth  of  this 
saliva  in  excessive  quantity  and  in  long,  slobbering  masses.  Then 
there  is  the  existence  on  one  of  the  faces  of  the  carious  tooth,  and 
principally  on  the  crown,  of  a  blackish  sj)ot,  or  of  a  hole,  or  of  a 
large  excavation,  penetrating  the  substance  of  the  tooth  at  a  vary- 
ing depth,  according  to  the  extent  of  the  disease  and  the  duration 
of  its  existence — the  Aaolent  pain  experienced  by  the  animal  when 
the  percussion  is  applied  on  the  tooth,  or  its  cavity  exploi-ed  with 
the  instrument — the  swollen  condition  of  the  gum  surrounding  the 
diseased  tooth ;  its  red  color ;  its  want  of  adherence  in  some  places, 
and  the  hemorrhage  with  the  oozing  of  pus  when  pressm-e  is  ap- 
phed  directly  over  those  same  places;  the  soUed  appearance  of 
the  dental  surfaces  on  the  side  of  the  diseased  tooth,  caused  by 
particles  of  food  remaining  adherent  to  their  anfractuosities,  and 
filling  up  the  cavity  of  the  carious  tooth,  or  forcing  themselves 
between  the  tooth  and  the  gum,  and  spreading,  diffusing  the  most 
repulsive  odor — these  all  belong  to  a  carious  condition  of  one  or 
more  of  the  teeth.  But  if  in  addition  to  this  the  caries  is  of  long 
standing,  and  has  advanced  towards  the  root  of  the  tooth,  the  or- 
dinary complications  pertaining  to  its  development  in  the  maxil- 
lary bone  at  the  alveola  take  place,  and  that  point  becomes  the 
seat  of  an  inflammatory  swelling,  manifested  externally  by  a  pain- 
ful enlargement,  hot  and  oedematous,  which  gradually  increases, 


OPERATIONS  ON  THE  TEETH.  333 

though  at  a  given  time  it  may  remain  stationary,  hard  and  resist- 
ing. Again,  as  the  progress  of  the  disease  continues,  the  hy^ier- 
trophied  dental  root,  by  its  continued  pressure  outward,  may 
destroy  the  external  surface  of  the  bone,  and  form  a  communica- 
tion between  the  bottom  of  the  diseased  alveola  and  the  external 
l^late  of  the  maxillary.  In  these  cases  pus,  saliva  and  putrefied 
food  collect  or  filtrate  into  the  subcutaneous  cellular  tissue,  and  an 
abscess  is  formed  which  soon  ulcerates  and  empties  itself  on  the 
surface  of  the  cheek.  Once  open,  this  abscess  has  no  tendency 
to  heal,  but,  on  the  contrary,  maintains  its  fistulous  form,  and  dis- 
charges through  its  opening  a  mixture  of  pus,  saliva  and  food, 
having  the  very  repulsive  and  characteristic  odor  already  men- 
tioned. Exploration  of  this  fistula  with  the  probe  will  give  different 
results  according  as  the  fistulous  tract  is  straight  or  irregular. 
In  the  first  instance,  the  j^robe  will  penetrate  directly  into  the 
mouth,  opening  on  one  of  the  faces  of  the  diseased  tooth,  or  even 
j)assing  into  the  center  of  its  carious  crown ;  while  in  the  other 
case  it  is  arrested  by  the  spongy  substance  of  the  ulcerated  max- 
illary; or  it  may  strike  against  the  root  of  the  diseased  molar. 

At  this  point,  changes  will  have  taken  place  in  the  mouth, 
upon  the  surface  of  the  teeth,  on  the  side  of  the  jaw  where  the 
disease  exists.  These  changes  vary,  and  consist  either  in  a  great 
obliquity  of  the  tables  of  the  teeth,  the  crowns  or  rubbing  sur- 
faces being  beveled  in  very  oblique  and  opposite  directions,  or  in 
the  well  marked  elevation  or  projection  of  the  molars  correspond- 
ing to  the  diseased  grinders,  in  the  healthy  jaw;  a  projection 
which  is  in  proportion  to  the  diminished  size  of  the  opposite 
carious  tooth  which  stands  much  lower.  The  first  condition  is 
observed  when  the  pain  caused  by  the  caries  has  entirely  prevent- 
ed mastication  on  the  diseased  side,  and  the  second,  when,  not- 
withstanding the  caries,  the  performance  of  mastication  has  still 
continued. 

The  condition  then  presented  by  the  carious  tooth  may  also 
vary.  In  some  cases  it  may  still  be  complete  in  its  alveolar  con- 
nection, though  otherwise  partly  destroyed,  and  yet  firmly  ad- 
herent by  its  root.  In  others  it  may  be  broken,  entirely  or  in 
fragments,  merely  parts  of  the  outer  surface  being  present; 
while  again,  some  broken  fragments,  more  or  less  detached,  may 
remain  in  the  alveolar  ca\'ities. 

Caries  of  the  first  and  second  superior  molars  may  become 


334  OPERATIONS    ON    THE    DIGESTIVE    APPARATUS. 

complicated  with  lesions  of  the  nasal  cavities,  when  the  ulcerating 
j)rocess  has  been  followed  by  a  perforation  between  one  or  other 
of  these  cavities  and  the  mouth.  This  lesion  is  accompanied  by  a 
discharge  taking  place  on  the  side  of  the  nose  corresponding  to 
that  of  the  diseased  tooth.  This  discharge  is  of  a  muco- purulent 
character,  and  mixed  with  saliva  and  food,  which  gives  it  the 
usual  foetid  odor  as  well  as  a  peculiar  green  aj^pearance.  It  is 
very  different  from  that  belonging  to  glanders,  and  is  too  charac- 
teristic to  justify  by  its  presence  an  error  in  diagnosis  in  that 
direction.  If,  however,  the  same  comj)lications  take  j)lace  in  the 
molars,  whose  roots  rest  on  the  sinuses  of  the  head,  the  symp- 
toms which  are  manifested  are  often  so  nearly  similar  in  aspect 
to  those  of  chronic  glanders,  that  the  commission  of  an  error 
should  not  be  considered  wholly  inexcusable.  Carefiil  examina- 
tion will  readily  bring  out  the  differential  diagnosis  between  the 
two  diseases,  though  so  different  in  their  ensemble.  When  the 
caries  of  one  of  these  last  molars  exists  to  such  an  extent  as  to 
transform  the  mucous  membrane  of  the  sinuses  into  a  sup- 
j)urative  surface,  and  to  cause  the  development  of  granulations 
upon  its  surface ;  or  to  allow  the  collection  of  pus  in  the  cavity  of 
the  sinuses,  a  discharge  becomes  established  through  the  nostril 
of  the  side  of  the  diseased  tooth  and  affected  sinus.  This  dis- 
charge is  white,  grumous,  very  abundant,  and  keej^s  increasing, 
and  has  also  an  extremely  foetid  odor,  identical  with  that  of  dental 
caries. 

The  lymphatic  glands  of  the  maxillary  space  then  become 
swollen,  hard,  though  painless,  and  loose  under  the  fingers.  The 
jDlates  of  the  zygomatic,  of  the  superior  maxillary  and  of  the 
nasal  become  swollen,  and  give  a  dull  sound  on  percussion. 
Sometimes  their  surfaces  are  so  thinned  out  that  it  flexes  under 
the  pressure  of  the  fingers,  and  they  are  then  surrounded  by  an 
oedematous  infiltration  of  subcutaneous  cellular  tissue. 

The  long  and  minute  consideration  which  we  have  thus  given  to 
the  diseases  of  the  dental  apparatus  has  been  principally  devoted 
to  the  molar  teeth  of  herbivorous  animals,  although  many  of  the 
conditions  observed  in  the  grinders  may  also  be  found  belonging 
to  the  incisors.  Indeed,  incisor  arches  may  also  offer  abnormah- 
ties  in  the  number  of  teeth,  in  theu'  position,  and  in  the  direction 
or  the  length  of  these  organs,  and  they  may  also  become  the  seat 
of   accidental   lesions,  such   as   fractures,  luxations,  or   the   too 


OPERATIONS  ON  THE  TEETH.  335 

rai^icl  wearing  of  various  jDarts  of  their  surfaces,  tliougli  it  seldom 
reaches  the  point  of  caries. 

The  different  indications  which  the  majority  of  these  patho- 
logical conditions  may  impose  resemble  so  nearly  those  required 
under  similar  circumstances  for  the  grinders,  that  it  becomes  un- 
necessary to  appropriate  a  special  chapter  to  their  discussion,  and 
we  therefore  proceed  to  the  consideration  of  the  general  opera- 
tions performed  upon  the  teeth,  according  to  the  indications 
which  may  be  from  time  to  time  presented. 

Operative  Dental  Surgery. 

Two  principal  indications  present  themselves  under  this  head- 
ing. First,  the  leveling  of  the  frictional  dental  surfaces,  for  the 
removal  of  any  existing  asperities  or  sharp  projections,  in  order 
to  estabhsh  a  perfect  coaptation,  as  well  as  the  free  movement 
necessary  for  the  execution  of  their  function  of  attrition.  Second, 
the  extraction  of  the  teeth  which  have  undergone  such  important 
alterations  in  their  stinicture,  that  their  conservation  becomes  in- 
compatible with  the  regular  execution  of  mastication,  or  because 
of  the  serious  compUcations  they  may  involve. 

Leveling  of  the  Dental  Arches. — The  original  mode  of  operat- 
ing to  level  the  molar  teeth  consisted  in  making  the  animal  chew 
on  the  blacksmith's  rasp.  It  is  a  simj)le  process,  easy  to  perform, 
without  danger  to  the  animal,  and  so  well  answering  the  purpose 
that  even  to-day  the  process  is  still  in  extensive  use.  But  this 
modus  operandi  is  not  without  its  inconveniences,  among  other 
objectionable  points,  requiring  to  be  repeated  for  several  days 
untn  perhaps  the  teeth  have  become  smooth  by  rubbing  against 
the  rough  surface  of  the  rasp — a  result  not  always  as  satisfactory 
as  it  might  be.  More  appropriate  instruments  have  therefore 
been  invented,  though,  in  point  of  fact,  none  of  them  are  other 
than  more  or  less  modified  rasps  or  files,  as  they  are  truly  called. 
Theu'  number  and  variety  are  to-day  very  great,  and  theu'  quali- 
ties vary  very  much,  according  to  the  taste,  the  ideas,  and  often 
the  dexterity  of  those  who  use  them.  Samples  of  these  files  are 
represented  in  Fig.  340,  and  according  to  their  general  construc- 
tion may  be  classified  as  rough  and  fine  rasps,  flat  and  angular, 
guarded,  double  and  single  on  one  or  other  of  their  edges.  Some 
are  simple,  and  formed  of  a  single  piece,  while  others  are  jointed 
and  compound,  and  may  be  screwed  or  unscrewed  with  facility 


336 


OPERATIONS    ON    THE    DIGESTIVE    APPARATUS. 


Fig.  340.— Samples  of  Tooth  Rasps. 

for  use  and  transi^ortation ;  some  have  the  rasp  fixed  to  a  solid 
handle,  and  again,  the  handle  in  others  is  moveable,  and  may  be 
changed  as  indications  may  present  themselves.  Their  number 
in  this  country  is  about  incomputable,  and  while  many  which  we 
find  registered  in  the  patent  ofiice  are  of  real  value,  many  others 
have  no  reason  for  being  beyond  theu'  maker's  whim.  As  we 
have  said,  the  advantages  which  any  of  them  may  possess  depend 
more  on  special  conditions  than  on  the  result  to  be  obtained,  in 
the  removal  of  the  small,  sharj)  edges  of  the  external  surface  of 
the  tooth,  or  its  lateral  faces,  resulting  from  an  excessive  develop- 
ment in  the  enamel. 

Whatever  may  be  the  file  which  the  veterinary  dentist  may  see 
fit  to  use,  the  manii^ulations  required  in  its  handhng  will  be  in  all 
cases  the  same.     In  referring  to  this,  the  first  question  which 
>  offers  is,  whether  the  use  of  the  speculum  is  necessary  to  enable 
the  surgeon  to  file  a  horse's  teeth?     There  is  no  doubt  that  in 
)  many  instances  it  will  be  difficult,  and  even  perhaps  impossible, 
I  to  compel  the  patient  to  keej^  his  mouth  sufiiciently  open  to  per- 
,j  mit  the  use  of  the  rasp  with  the  necessary  delicacy  and  freedom,  or 
prevent  him  from  constantly  biting  it,  or  keeping  his  jaws  closed 
during  the  oj^eration.     In  every  instance,  the  play  of  the  instru- 
ment wiU  be  sure  to  be  interfered  with  by  the  excited  jDatient. 

We  believe  that  American  practitioners  were  the  first  to  dis- 
pense with  the  sjDCculum  in  these  cases ;  and  that  to  Mr.  House, 
a  celebrated  veterinary  dentist,  who  died  not  many  years  ago,  is 
due,  in  fact,  the  paternity  of  this  specialty  in  veterinary  surgery. 
Whether  the  mouth  of  the  animal  is  held  open  with  a  sj)ecu- 


OPERATIONS  ON  THE  TEETH.  337 

lum,  and  tlie  tongue  drawn  out  and  held  on  one  side  by  an  assist- 
ant, or  whether  the  operator  himself  controls  the  tongue  with  one 
hand  while  working  the  instrument  with  the  other,  the  manipula- 
tions must  be  the  same,  viz. :  the  passage  to  and  fro  of  the  file  over 
the  surfaces  requiring  to  be  corrected,  wherever  they  are  rough 
and  sharp ;  filing  them  just  as  the  smith  files  the  iron  he  is  shap- 
ing as  he  holds  it  in  the  vise.  We  believe,  however,  that  the 
rasping  out  ought  to  be  done  slowly,  softly  and  without  giving  the 
animal  any  cause  for  fright  or  excitement.  The  method  sometimes 
practiced  of  vising  the  rasp  with  a  succession  of  rapid  movements 
over  the  dental  arches  is  certainly  dangerous  and  liable  to  be  ac- 
companied with  accident  to  the  patient.  An  irritable,  struggling 
animal,  by  violent  movements  of  the  head,  or  in  his  attempts  to 
chew  on  the  rasj),  may  easily  receive  injuries  from  the  rough  con- 
tact of  the  instrument  with  the  delicate  structures  of  the  mouth. 
After  such  a  passage  of  the  rasp  a  number  of  times  over  the  teeth, 
the  hand  introduced  in  the  mouth  will  at  once  detect  the  effect 
upon  the  patient. 

Although  the  use  of  the  speculum  may  be  advantageous  in 
many  instances,  there  is  certainly  a  risk  attending  its  use,  in  the 
possibility  of  bruises  and  lacerations  which  may  occur  at  the  bars 
when  the  animal,  annoyed  by  its  application,  chews  upon  it  in  his 
endeavors  to  close  his  mouth. 

The  work  of  filing  when  the  teeth  are  sharp  is  of  common  in- 
dication, and  finds  its  direct  appUcation  under  the  special  condi- 
tion that  the  edges  or  asperities  which  are  treated  should  not  be 
too  large  or  too  prominent.  If  this  should  be  the  case,  and  the 
inefficiency  of  the  file  or  rasp,  however,  become  evident  in  the  trial, 
other  means  remain  for  accomplishing  the  desired  pui-pose.  Such 
a  contingency  was  not  lost  sight  of  in  former  years,  and  chisels 
and  gouges  were  then  employed  to  reduce  the  excessively  devel- 
oped projections  of  enamel. 

With  these  instrimients  the  patient  was  either  thrown  or  treat- 
ed on  his  feet,  his  mouth  being  opened  with  a  speculum,  with  his 
tongue  di-awn  out  and  held  on  one  side.  The  chisel  was  then  laid 
against  the  dental  projection,  and  an  assistant  striking  it  with  a 
hammer,  the  excess  of  tooth  was  knocked  off.  Bouley  considered 
this  mode  of  operation  dangerous.  "  The  chisel  might,  under  the 
impulse  received  by  the  hammer,  slide  in  the  mouth  and  severely 
injure  the  tongue,  the  cheeks,  and  the  soft  or  the  hard  palate ;  or 


338  OPERATIONS    ON    THE    DIGESTIVE    APPARATUS. 

in  animals  advanced  in  age,  the  tooth  might  be  fractured  or  dis- 
located; or  again,  the  operator  himself  might  be  injured  by  the 
instrument,  when,  suddenly  displaced  by  a  movement  of  the  ani- 
mal, the  assistant  knocks  against  it." 

It  was  to  remedy  this  objection  that  Brogniez  invented  his 
odontritor  (Fig.  341),  an  instrument  which  carries  on  one  end  a 
blade  sharpened  on  both  edges,  and  on  the  other  is  hollowed  out, 
in  order  to  allow  the  play  of  a  rod  through  one-half  of  the  length 
of  the  instrument.  This  rod  is  provided  with  a  transversal  handle, 
which  also  acts  as  a  hammer,  by  which  the  blow  is  carried  against 
the  sharp  edges  of  the  tooth. 

When  the  odontritor  is  used,  it  is  not  necessary  to  use  a  spec- 
ulum to  open  the  mouth,  the  holding  of  the  tongue  out  of  the 
mouth  being  sufficient.  The  operator,  holding  the  instrument 
with  the  left  hand,  places  the  anterior  sharp  edge  against  the  j^ro- 
jecting  portion  of  the  tooth,  and  holding  the  rod  by  the  handle 
full  in  his  right  hand,  moves  it  to  and  fro,  striking  at  the  j)roper 
points  as  he  moves  it.  This  operation  is  repeated  on  both  jaws 
until  all  the  sharper  edges  of  the  teeth  have  been  cut  off,  and  is 
completed  by  passing  the  rasp  over  the  dental  plates,  as  is  done 
when  the  teeth  are  not  too  sharp. 

Several  modifications  have  been  made  in  the  conformation  of 
the  odontritor,  but  that  of  Prange  is  probably  the  best  (Fig.  342) 
It  consists  in  ha%ing  three  blades,  which  may  be  changed  at  will 
and  which  vary  in  the  form  and  disposition  of  their  cutting  edges. 
This  instrument  is  considered  superior  to  that  of  Brogniez,  and 
is  thought  to  work  to  better  advantage  when  the  elevation  of  the 
tooth  is  well  marked. 

The  odontritor  answers  perfectly  for  leveling  the  molars  when 
the  projections  are  not  excessively  developed,  or  do  not  offer  too 
great  resistance  to  the  action  of  the  blade.  But  when  an  entire 
tooth  projects  above  the  general  level,  the  odontritor  ceases  to  be 
of  any  advantage,  and  it  becomes  necessary  to  perform  the  resec- 
tion of  the  tooth,  consisting  in  the  removal  of  all  that  portion  of 
it  which  rises  above  the  level  of  the  general  dental  surface. 

To  Brogniez  is  due  again  the  first  instrument  invented  for  the 
performance  of  this  operation  in  the  chisel  odontritor  (Fig.  343). 
This  is  composed  of  two  rods,  one  of  them  having  at  one  end,  like 
the  ordinary  odontritor,  a  frame  of  sufficient  dimensions  to  allow 
the  entire  molar  to  pass  through  it,  and  on  the  anterior  border  of 


OPERATIONS    ON    THE    TEETH. 


339 


Fig.  341 — Brognioz'8  Odontritor. 


Fig.  342.— PrangS's  Odontritor. 


340  OPERATIONS    ON    THE    DIGESTIVE    APPARATUS. 

tliis  frame  a  solid  blade  with  a  sharp  con- 
cave edge  turned  backward.  The  other 
extremity  of  this  rod  carries  a  transverse 
prolongation,  which  serves  to  change  the 
position  of  the  blade  when  necessary,  and 
which  has  on  its  shorter  portion  a  hole 
through  which  the  other  rod  is  allowed 
to  shde.  This  second  rod  has  on  one  end 
a  sharp  blade  which  slides  into  suitable 
grooves  made  in  the  frame  of  the  first, 
and  is  curved  forward  on  its  front  edge. 
On  the  other  extremity  it  carries  a  metal- 
lic mass  which  is  used  as  a  hammer. 

In  using  this  instrument,  the  tooth 
being  enclosed  in  the  frame  between  the 
two  blades,  the  movable  rod,  with  its  sharp 
edge,  is  pushed  against  the  blade  of  the 
frame,  and  a  strong  blow  of  the  hammer 
cuts  off  the  tooth  smoothly  and  evenly. 

The  chisel  invented  by  Gowing  (Fig. 
344),  works  somewhat  on  the  same  princi- 
ple as  that  of  Brogniez. 

Resection  of  the  teeth  has  also  been  per- 
formed with  the  instruments  used  for  the 
same  operation  on  bones.    Saws  of  various 
form  and  design  are  also  recommended, 
the  chain  saw,  which  we  have  often  used, 
being  one  of  these.     But  there  are  serious  Fig.344— Gow- 
objections  to  this  latter  instrument,  among 
which  is  its  liabihty  to  become  heated  while  in  use, 
when  it  becomes  unable  to  "  bite  "  upon  the  hard 
dental  substance,  and  may,  moreover,  break  or  slide. 
The  only  method  of  overcoming  these 
objections,  which,  in  fact,  may  occur 
in  using  any  kind  of  saw,  is  by  hold- 
ing a  wet  sponge  against  the  tooth  to 
which  the  instrument  is  apjjlied — a 
precaution  which  is  not  always  of  easy 
adoption,  and  which  can  scarcely  be 
effected  without  more  or  less  danger 
of  wounding  the  hand  which  holds 

Fir,.  34.3.— Brogniez's  Tooth  Chisel. 


OPERATIONS    ON    THE    TEETH. 
Fig.  3J5. 


341 


Schemer's  Extractor  and  Molar  Cutter. 


342  OPEBATIONS   ON    THE    DIGESTIVE   APPABATUS. 


Fig.  345a.— Hamlin' 8  Molar  Cutter. 

the  sponge.  But  when  none  of  these  modes  of  operation  can  be 
readily  applied,  the  use  of  the  tooth-chisel  becomes  the  order. 
Its  apphcation  is  simple,  and  with  a  well-made  instrument  in  the 
hands  of  an  expert  operator,  quick  and  strong,  the  resection  can 
be  readily  performed. 

The  array  of  tooth-chisels  or  resectors  is  beyond  compute  in 
variety  and  number,  and  especially  in  this  country  where  the  in- 
stinct of  mechanical  invention  is  so  universal,  and  the  specialty  of 
veterinary  dentistry  is  so  extensively  practiced,  and  many  different 
kinds  can  be  inspected  among  the  samples  of  workmanship)  which 
decorate  the  show-cases  of  our  instrument  makers.  Among  the 
principal  forms,  we  may,  however,  mention  those  which  recall  the 
names  of  Lafosse,  Moller,  Scheffers,  Gowing  in  Euroj)e,  and  of 
Clarke,  House,  Liautard  and  Hamlin  in  this  country  (Figs.  345, 
S45«).  Some  of  these  instruments  have  theii'  jaws  closed,  others 
have  them  open.  Some  work  by  a  pecuhar  thread-screw  arrange- 
ment, others  by  the  manual  power  of  the  operators ;  and  again, 
the  blades  of  some  are  straight  and  others  cmwed,  and  still  others 
are  sharp  hke  a  concave  saw.  In  theii-  apphcation  they  all  work 
upon  about  the  same  principle,  and  are  used  in  the  same  man- 
ner. The  mouth  being  opened,  the  tooth  is  seized  between  the 
jaws  of  the  forceps,  and  by  the  pressiu^e  of  the  screw  with 
which  some  of  them  are  armed,  or  by  the  unaided  strength  of  the 
operator,  the  tooth  is  squeezed  and  cut  off  with  a  sudden  snap, 
followed  by  the  dropping  out  of  the  mouth  of  the  amputated 
portion.  As  a  rule,  the  sm-face  left  on  the  tooth  shows  but  a 
shght  roughness,  which  can  be  smoothed  off  with  the  rasp. 


OPERATIONS    ON    THE    TEETH. 


343 


Extraction  of  Teeth. 

The  extraction  or  removal  of  teeth  is  indicated  for  the  reduc- 
tion of  any  excess  in  their  number,  which  may  interfere  with  mas- 
tication ;  or  when  these  organs  are  abnormal  in  form  or  direction, 
and  obstruct  the  growth  or  usurp  the  jDlace  of  a  permanent  tooth  ; 
or  when  they  are  diseased  with  caries,  or  affected  with  any  of  the 
pathological  conditions  which  we  have  before  considered ;  or  when 
they  become  the  cause  of  a  dental  fistula. 

To  extract  the  incisors  of  any  of  our  domestic  animals,  the 
molars  of  dogs,  or  the  caduc  molars  of  large  herbivorous  animals, 
some  of  the  various  forms  of  tooth  forceps  that  are  used  in  human 


Fig.  346.— Samples  of  Tooth  Forceps. 

dentistry  or  the  different  shapes  of  the  key  of  Garangeot  or  special 
larger  forceps,  such  as  that  of  LeceUier  (Fig.  348)  or  the  enlarged 
Garangeot's  key,  as  modified  by  Delamarre  (Fig.  349),  w^iU  be 
necessary.  The  modus  operaiuli  is  generally  simj^le ;  the  tooth, 
still  firmly  attached  to  its  alveola,  or  perhaj)s  loose  and  more  or 


344 


OPEKATIOXS    ON    THE    DIGESTIVE   APPAEATUS. 


Fig.  347.— Garangeot's  Keys. 

less  puslied  out  of  its  place  by  a  succeeding  growtli,  is  seized  be- 
tween the  jaws  of  the  forceps,  or  of  the  Garangeot's  keys,  and  is 
easily  wrenched  from  its  position  by  a  strong  pull  or  with  a  sUght 
twisting  motion  sufficient  to  lacerate  its  last  adhesions. 

The  extraction  of  the  permanent  molars  of  a  horse  is  a  diffi- 
cult and,  under  some  circumstances,  a  serious  operation.  Their 
mode  of  implantation  and  insertion  in  the  alveolar  cavities ;  the 
great  length  of  then-  roots  as  compared  to  the  small  dimensions 
of  their  free  portion;  the  narrow  connections  which  exist  be- 
tween them,  and  withal,  the  solidity  of  the  dental  arch — all  these 
conditions  are  sufficient  to  explain  the  serious  character  of  the 
prognosis  of  this  ox^eration,  and  the  difficulties  which  are  often 
encountered  when  the  organ  to  be  removed  is  the  molar  tooth  of 
a  horse.  These  difficulties,  however,  vary  considerably  under  -pe- 
culiar  conditions,  such,  according  to  Peuch  &  Toussaint,  as  "  the 
age  of  the  subject,  the  position  of  the  tooth  on  one  or  the  other 
jaw,  and  the  degree  of  alteration  of  the  tooth  to  extract." 

For  examjole,  the  operation  is  more  difficult  in  young  animals 
than  in  adult,  or  older  subjects,  the  latter  requmng  less  effort, 
the  root  of  the  tooth  being  shorter  and  the  adhesion  to  the  alveola 
less   solid.     The  upper  are  less  firmly  attached  than  the  lower 


OPEEATIOXS    ON    THE    TEETH. 


345 


^^^^^^ 


Fig.  348.— Lecellier's  Tooth  Forceps 
for  Molar. 


Fig.  349.— Garangpot's  Keys,  Modi 
by  Delamarre. 


molars,    the   presence   of   the   cavities   of   the   sinuses,    and  the 
diminished  thickness  of  the  walls  of  their  alveola  rendering  theii- 


346 


OPEEATIONS    ON    THE    DIGESTIVE    APPARATUS. 


insertion  and  implantation  less  tenacious  than  in  the  lower.  The 
extraction  of  the  front  is  less  difficult  than  that  of  the  posterior 
molars.  At  times,  as  when  the  teeth  are  partly  destroyed  by 
caries,  a  single  effort  will  be  suffi- 
cient to  extract  them ;  but  in  other 
cases,  as  when  the  periosteum  is  dis- 
eased, and  the  roots  adhere  more 
intimately  to  the  alveola,  the  extrac- 
tion becomes  very  difficult.  And 
again,  if  the  tooth  having  a  hyper- 
trophied  root,  resists  the  action  of 
the  instruments  through  the  op- 
position of  those  immediately  sur- 
rounding it,  which,  though  healthy, 
are  less  firmly  fixed  in  their  alveola, 
which  are  mechanically  dilated  by 
the  outward  pressure  made  upon 
the  plates  of  the  maxillary  bone,  is 
easy  to  loosen  and  dislocate  them ; 
and  this  is  a  circumstance  which 
must  not  be  overlooked  during  the 
manipulation  required  for  the  ex- 
traction, in  order  to  avoid  serious 
disturbances  of  the  dental  appa- 
ratus. 

In  the  extraction  of  a  molar,  the 
patient  must  be  thrown,  and  the 
head  well  elevated,  the  mouth  being 
kept  well  open  by  means  of  a  per- 
fectly safe  speculum,  such  as  that  of 
Lecellier  (Fig.  350),  but  we  think 
it  rather  clumsy  to  handle.  Bouley 
recommends  the  etherization  of  the 
patient.  The  mouth  is  to  be  thor- 
oughly cleansed.  There  are  cu'cum- 
stances,  however,  in  which  the  op- 
eration of  castiag  is .  unnecessary, 
and,  in  fact,  our  own  j)ersonal  ex- 
perience has  raised  doubts  in  our 
PiG.sso-SpecuiumofLeceuier.      "lii^cl   as   to  the   necessity  at   any 


OPEKATIONS    OX    THE    TEETH. 


347 


Fig.  351.— Plasse  Molar  Extractor  (full  view).  Fig.  352.— The  eame  (side  view). 


348  OPERATIONS    ON    THE    DIGESTIVE    APPARATUS, 

time  of  exposing-  the  animal  to  the  possible  accidents  which  mar 
attend  this  mode  of  restraint.  We  hold  strongly  to  the  expedi- 
ency of  performing  the  operation  in  the  standing  position.  There 
will  necessarily  be  cases  in  which  to  attempt  to  remove  a  tooth 
with  the  animal  standing  would  be  simple  folly  and  time  lost,  but 
with  many  operators  in  this  country,  we  have  in  several  instances 
succeeded  in  extracting  a  condemned  molar  without  any  other 
means  of  restraint  than  a  twitch  on  the  patient's  lower  lip  or  on 
his  ear.  The  removal  of  molars  is  effected  in  two  ways — by  pul- 
hng,  or  by  rejjulsion  or  gouging  out. 

The  method  by  extraction  or  emdsion,  is  preferable  whenever 
it  is  practicable,  having  the  advantage  of  causing  less  injury  to 
the  surroimding  structures,  and  is  objectionable,  principally  for 
the  posterior  teeth,  which  always  oppose  great  difficulties  to  the 
operation.  The  oldest  instrument  used  in  this  operation  is  the 
enlarged  key  of  Garangeot,  as  modified  by  Delamarre.  Its  appli- 
cation has  always  seemed  to  us  difficult,  if  not  dangerous,  and  we 
think  that  it  involves  more  or  less  risk  of  fracture  of  the  plates  of 
the  maxillary  bone,  on  which  account  we  prefar  the  large  tooth 
forceps,  which  may  be  found  under  many  forms  and  designs.  The 
forceps  of  Plasse  (Fig.  351),  of  Wendenburg  (Fig.  353),  of  Pill- 
wax  (Fig.  354),  of  Gowing  (Fig.  355),  of  the  same  inventor,  as 
modified  by  Bouley  (Fig.  356),  those  of  Gunther  (Fig.  358),  the 
key-forceps  of  Bouley  (Fig.  357),  those  of  House,  of  Walters,  and 
many  others  will  furnish  the  operator  a  large  collection  from  which 
to  select.  Many  of  these  instruments  are  very  compHcated  (as  that 
of  Scheffer) ;  some  are  clumsy  and  difficult  to  handle ;  have  levers, 
like  those  of  Wendenburg  and  Pillwax;  many  woi'k  by  merely 
grasping  the  tooth  and  holding  it  by  a  peculiar  arrangement  of 
spring,  or  of  thread-screw,  and  thus  to  the  end  of  the  chapter. 

We  have  for  many  years  given  the  preference  to  the  simple 
forceps  of  Gowing,  leaving  off  the  little  rod  which  is  connected 
with  the  cross-piece  which  carries  the  thread,  and  which  is  to  be 
screwed  on  the  handles  of  the  instrument  to  hold  them  firmly  to- 
gether. What  we  think  most  essential  in  the  instrument  is  that 
its  arms  should  be  firm  and  so  soHd  as  not  to  bend  or  yield  when 
the  screw  is  applied  on  them,  and  that  the  jaws  of  the  forceps 
should  not  be  too  narrow  nor  too  curved,  and  above  all,  that  the 
instrument  should  not  be  made  mmecessarily  heavy,  a  fault  which 
we  have  too  often  observed  in  some  of  the  continental  pattei-ns. 


OPEKATIONS    ON    THE    TEETH. 


349 


(D 


Fig  353.— Wendenburg 
Forceps. 


Fig.  354.— Pillwax's 
Forceps. 


Fig.  355.— Gowing's 
Forceps. 


Besides  the  forceps  which  we  have  named  there  are  many 
others,  but  whatever  may  be  their  plan  or  shape,  the  manner  of 
using  them  includes  nearly  the  same  manipulations  for  all.  These, 
in  their  various  steps,  are  done  about  as  follows :  the  animal  be- 
ing properly  secured,  with  his  mouth  open,  and  his  tongue  drawn 


350 


OPERATIONS    ON    THR    DIGESTIVE    APPARATUS. 


Fig.  356.— Gowing's  Forceps,  Modified  by  Bouley. 

out  on  one  side,  an  assistant  inserts  the  forceps  into  the  mouth, 
adjusting  it  to  the  tooth  to  be  extracted,  and  notifies  the  op- 
erator of  the  moment  when  he  can  close  the  jaws  of  the  instru- 
ment together,  which  is  done  in  various  ways  according  to  the 
kind  of  instrument  in  use.  When  the  tooth  is  properly  seized 
and  firmly  held  by  the  forceps,  the  operator,  using  all  his  force, 
carefully  and  slowly  oscillates  the  instrument  from  left  to  right, 
and  from  right  to  left,  in  order  to  produce  the  gradual  dislocation 
of  the  organ,  and  when  it  is  loosened  from  its  attachments  it  is 
drawn  vertically  out  of  its  cavitj  by  a  final  movement  of  eAoilsion. 
There  are  instruments  possessing  a  lever  attachment  close  to  the 


OPEBATIONS    ON    THE    TEETH. 


FlO.  357.— Bouley's  Tooth  Keys. 

jaws  by  which  the  extraction  of  the  tooth  is  considerably  facilitat- 
ed. If  the  animal  has  not  been  put  under  general  anesthesia  the 
dislocation  of  the  tooth  is  very  painful,  and  often  accompanied  by 


352 


OPERATIONS    ON    THE    DIGESTIVE    APPARATUS. 
ABC 


Pig.  358.— Gunther's  Forceps. 

violent  struggles,  at  the  critical  moment ;  and  if  tlie  tooth  is  not 
very  strongly  held  by  the  forceps,  it  is  possible  that  it  may  slij) 
out  of  the  jaws  of  the  instrument  and  di-op  into  the  mouth.  To 
avoid  the  possibility  of  its  passing  into  the  pharynx,  we  think  it 
would  be  but  a  prudential  measure  to  have  an  assistant  keep  his 
hand  in  the  animal's  mouth  ready  to  secure  the  tooth,  if  necessary, 
before  it  passes  beyond  the  soft  palate. 


OPERATIONS  ON  THE  TEETH.  353 

'  The  second  mode  of  extracting  molars,  or  that  by  repulsion  or 
{/ouglng,  is  the  only  one  possible  under  all  the  circumstances, 
when  the  prehension  of  a  carious  or  diseased  tooth  cannot  be 
effected  by  the  instrument  used  in  the  first  method,  as,  for  in- 
stance, in  cases  of  disease  of  the  posterior  molars  when  the  carious 
tooth  is  so  far  diseased  or  destroyed  that  not  enough  of  its  sub- 
stance remains  above  the  root  to  be  reached  by  the  forceps ;  or 
again,  when  the  exostosis  of  the  root  has  reached  such  dimensions 
that  it  will  not  allow  its  exit  from  the  alveolar  cavity,  whatsoever 
efforts  may  be  made  to  overcome  its  resistance. 

This  operation  was  first  recommended  by  H.  d'Arboval,  and 
although  it  has  been  condemmed  by  some  practitioners,  is  certainly 
indicated  for  all  operations  upon  the  molars.  All  the  superior 
molars,  together  with  the  three  anterior  inferiors,  are  readily 
reached  by  their  roots,  in  trephining  the  external  plate  of  the 
bones  in  which  they  are  implanted.  The  posterior  inferiors  are 
the  only  ones  that  present  any  serious  objections,  and  the  trouble 
is  truly  a  tangible  one,  being  nothing  less  than  the  necessity  of 
passing  through  the  entire  thickness  of  the  masseter  muscle. 

The  tooth  demanding  removal  being  surely  identified,  and  the 
impossibility  of  removing  it  by  the  mouth  well  estabhshed,  the 
animal  is  thrown  on  the  side  opposite  to  that  which  is  occupied 
by  the  diseased  organ,  and  placed  under  complete  anesthesia. 
The  location  of  the  alveolar  walls,  upon  which  the  operation  is  to 
be  made  in  order  to  reach  the  root  of  the  tooth,  must  be  first  well 
determined.  If  it  is  one  of  the  last  three  upj)er  molars,  it  will  corres- 
pond to  the  sinuses.  But  the  operator  must  not  allow  himself  to 
be  deceived  by  the  presence  of  a  fistulous  opening,  which,  by  ap- 
pearing on  the  surface  of  the  skin  to  indicate  the  j^oint  of  attack, 
may  in  fact  mislead  him  by  conducting  him  to  a  point  consider- 
ably remote  from  the  diseased  tooth.  A  positive  and  satisfactory 
diagnosis  being  settled,  and  the  hair  being  clipped,  a  large  V  or 
cross-shaped  incision  is  made  over  the  spot  selected  for  the  tre- 
phine, and  carefully  avoiding  the  infliction  of  any  injury  to  the 
muscles  of  the  region,  the  sinuses  are  opened  by  removing  two 
or  three  circular  portions,  at  a  tangent  to  each  other,  to  effect  the 
removal  of  a  fair-sized  piece  of  the  bone.  The  edges  or  prol6nga- 
tions  which  remain  are  levelled  off  with  the  bone  forcei:)S,  which 
is  certainly  preferable  to  any  other  means ;  or  if  the  opening  made 
in  the  bone  is  too  small,  it  can  also  be  enlarged  by  using  the  same 


354  OPERATIONS    ON    THE    DIGESTIVE    APPARATUS. 

bone  forceps,  by  nipping  oflf  fragments  from  the  edges  and  making 
entrance  into  the  sinuses  of  the  proper  dimensions.  The  wound 
and  the  sinuses  are  then  thoroughly  cleaned  out,  and  the  blood 
and  the  pultaceous  pur;ilent  collection  found  in  theii*  bottom 
thoroughly  removed.  This  exposes  the  root  of  the  tooth,  in  the 
form  of  a  hard,  dry,  greyish  mass,  analagous  to  a  piece  of  necrosed 
bone.  The  operator,  then  holding  the  hlunt  gouge,  or  repoussoir 
in  his  left  hand,  apphes  it  through  the  sinuses  against  the  middle 
of  the  dental  root,  and  with  a  strong  mallet  held  in  his  right, 
strikes  upon  it  with  firm  and  steady  blows.  The  mou.th  of  the 
animal  being  held  open  by  the  speculum,  an  assistant  with  his 
hand  upon  the  crown  of  the  tooth  studies  the  effect  of  each  blow, 
and  notes  as  it  yields  to  the  percussion,  and  inoves  and  loosens  lontil 
it  becomes  detached,  and  faUs,  hberated  into  his  hand,  secured 
l^y  his  continuous  grasp  from  any  possible  danger  of  being  swal- 
lowed. As  a  riile  the  tooth  is  pushed  out  of  its  cavity  by  the  first 
blows,  either  entu-e  or  in  as  many  portions  as  it  may  have  been 
divided  into  by  the  carious  process.  But  at  times  it  becomes 
necessary  to  repeat  the  percussion  and  to  use  considerable  force 
to  compel  it  to  leave  the  jaw. 

The  modus  operandi  is  about  the  same  for  any  of  the  molars, 
though  for  the  lower  teeth  greater  force  in  the  blows  of  the  mal- 
let is  generally  required,  in  consequence  of  the  greater  thickness 
of  the  walls  of  the  alveolar  cavities  in  the  lower  maxillary  bone. 
If  it  is  one  of  the  posterior  lower  molars  which  is  the  subject  of 
the  operation,  the  masseter  muscle  must  be  cut  thi-ough,  but  the 
general  manipulations  are  otherwise  the  same,  care  being  required, 
however,  to  avoid  injury  to  the  glosso-facial  artery,  or  the  duct  of 
Steno. 

Though  apparently  a  severe  ojDeration,  this  is  not  a  dangerous 
one,  the  wounds  which  it  involves  healing  rajjidly,  and  the  great 
advantages  which  are  realized  by  it,  among  which  may  be  included 
the  cleansing  of  the  sinuses,  and  the  removal  of  their  suppurative 
collection,  which  could  not  be  otherwise  secured,  amply  compen- 
sating for  the  severity  of  the  process. 

After  the  operation  the  wound  is,  of  course,  to  be  thoroughly 
cleansed,  fragments  of  bone  to  be  removed,  and  acidvdated  gargles 
used  to  wash  the  mouth  and  the  cavity  of  the  alveola  of  its  blood. 

The  cicatrization  of  the  external  wound  generally  gives  no 
trouble  to  the  siu'geon,  and  requires  no  particular  methods  be- 


OPERATIONS    ON    THE    TEETH. 


355 


yond  those  of  ordinary  cleanliness  and  proper  attention  to  the 
granulating  process.  It  is  the  cicatrization  of  the  internal  wound 
which  requii-es  attention,  and  in  some  cases  a  great  deal  of  it. 
This  is  in  order  to  guard  against  the  collecting  and  the  packing  of 
the  food  in  the  cavity  of  the  alveola,  and  thus  interfering  with  its 
closing  up  by  proper  granulations.  The  diet  of  animals  thus 
operated  on  must,  of  course,  consist  almost  entii'ely  of  liquid  food, 
as  mashes  of  bran  or  of  oatmeal;  hay  teas,  flour  water,  milk,  etc., 
or  of  cooked  roots,  scalded  grains  and  the  like.  According  to 
some  authors,  fibrinous  food  is  dangerous  only  during  the  early 
days  immediately  following  the  operation,  but  our  experience  has 
taught  us  that  neither  solid  nor  semi-solid  food  is  to  be  allowed 
to  an  animal  which  has  lost  a  molar  tooth,  for  a  period  of  from 
three  to  four  weeks,  and  during  that  time  the  alveolar  cavity  ought 
to  be  thoroughly  cleansed  out  after  every  meal,  until  all  possibility 
of  danger  has  subsided. 

The  vacuum  left  in  the  dental  arch  after  the  removal  of  a  tooth 
is  never  entirely  filled  up,  but  it  gradually  diminishes,  in  conse- 
quence of  the  oblique  direction  which  the  teeth  in  front  and  behind 
ai'e  disposed  to  assume,  and  which,  though  it  brings  them  closer 
to  each  other,  never  brings  them  into  actual  contact.  It  may  hap- 
pen that  by  reason  of  this  vacant  space  the  tooth  on  the  opposite 
side  of  the  jaw  may  acquire  a  tendency  to  grow  to  excess,  and  from 
want  of  wear,  ultimately  project  above  the  level  of  the  other  teeth. 
In  reference  to  this  it  wiU  be  but  prudent  to  watch  the  condition 
of  that  particular  tooth,  and  to  be  prejDared  to  reduce  it  to  its 
proper  level,  if  that  should  become  necessary. 

In  reference  to  accidents  that  may  occur  during  operations 
upon  the  teeth,  we  have  already  mentioned  the  possibihty  of  deg- 
lutition of  the  tooth  as  it  is  drawn  from  its  socket.  In  some  cases 
reported  by  Eenault  and  Bouley  fatal  results  have  followed,  caused 
by  violent  coUcs  thus  induced.  Strong  cathartics  have  been  rec- 
ommended in  these  cases  for  the  removal  of  the  foreign  body,  but 
the  precaution  which  we  have  already  mentioned  will  eflfectuaUy 
prevent  the  possibihty  of  this  accident.  Bruises  and  excoriations 
of  the  bars,  with  the  speculum,  and  hemorrhage,  are  accidents 
which  also  sometimes  accompany  these  operations  of  extraction. 
The  first  is  not  usually  a  matter  of  any  importance,  unless  necro- 
sis of  the  jaw  should  follow  ;  and  as  for  the  hemorrhage,  unless  it 
results  from  du'ect  injury  to  the  palatine  artery,  it  is  easily  con- 


356  OPEKATIONS    ON    THE    DIGESTIVE    APPARATUS. 

trolled  by  pressure  and  packing  with  oakum  or  compressed 
sponges.  Fractures  of  the  alveola,  or  of  the  lower  maxUlary 
bone,  are  of  a  more  serious  character  than  any  of  the  preceding 
injuries,  the  last,  mentioned  in  a  case  recorded  by  Koerter,  having 
necessitated  the  destruction  of  the  animal. 

Filing  Teeth. 
This  operation  has  not,  we  beheve,  as  yet  entered  into  the 
general  practice  of  veterinary  surgery,  and,  with  the  exception  of  a 
few  veterinarians  on  this  continent  who  have  attempted  it,  we  think 
that  in  the  presence  of  the  many  difficulties  which  exist  in  realiz- 
ing a  perfect  result,  similar  to  those  obtained  with  the  thorough 
work  of  hujnan  dentistry,  it  will  be  some  time  before  this  branch 
of  veterinary  dentistry  can  be  practiced  with  any  great  prospect  of 
good  and  permanent  results.  Our  experience  in  filing  the  teeth 
of  our  domestic  animals  is  very  Hmited,  and  on  that  account  we 
will  refrain  from  sajdng  more  about  it,  referring  our  readers  to 
the  work  of  Dr.  Hinebauch  on  "Veterinary  Dental  Surgery," 
where  the  subject  is  treated  rather  extensively. 

Canine  Dentistky. 

Operations  on  the  teeth  of  the  dog  are  sometimes  indicated 
under  some  peculiar  and  abnormal  conditions,  such  as  irregu- 
larity in  number  or  in  direction,  or  in  cases  of  traumatism,  such 
as  fractures  or  dislocations.  Their  extraction  is  performed  with 
tooth  forceps,  as  we  have  already  had  occasion  to  remark.  Their 
resection  has  been  recommended  by  a  French  veterinarian,  Mr. 
Bourrel,  as  a  means  of  preventing  rabid  inoculation  (Fig.  359). 
The  operation  is  a  very  simple  one,  and  consists  in  smoothing 
over  the  sharp  points  of  the  teeth  with  a  file,  though  sometimes 
sharp  nippers  are  used  in  preference. 

But  an  operation  which  is  of  daily  necessity  is  that  of  clean- 
ing the  teeth  by  removal  of  the  accumulatiou  of  cement  or  tartar, 
which  gathers  on  the  external  surface  of  the  tooth,  at  its  insertion 
in  the  alveolar  cavity,  where  it  forms  a  thick  crust,  of  greenish 
gray  color,  composed  of  microscopic  fungi.  In  neglected  cases, 
the  gums  become  irritated  and  ulcerated,  and  the  tooth,  jDartially 
denuded  of  its  gum,  exposes  not  only  its  free  portion,  but  por- 
tions of  the  root  also,  sometimes  even  becoming  loose  and  drop- 
ping out  of  the  jaw.     There  is  in  these  cases  a  free  and  abundant 


OPERATIONS    ON    THE    TEETH. 


357 


Fig.  359.— Bourrel's  Mode  of  Filing  Dog's  Teeth. 

flow  of  saliva,  of  a  characteristic  and  putrid  smell ;  mastication 
becomes  impossible,  and  the  animal  becomes  a  regular  martyr  to 
the  lack  of  attention  of  his  dental  apparatus.  The  formation  of 
these  concretions  can  be  prevented  in  animals  in  the  same  way  and 
with  the  same  care  that  is  exercised  in  respect  to  the  human  when 
teeth- washing,  brushing,  etc.,  with  some  of  the  properly  com- 
pounded tooth  powders,  will  remove  a  slight  coat  of  the  offensive 
deposit,  but  if  the  accumulation  is  quite  large,  it  must  be  scraped 
off  with  proper  instiniments  (Fig.  360),  carefully  avoiding,  if  prac- 
ticable, any  injury  to  the  gums,  or  the  loosening  of  the  teeth. 


Fig.  360.— Tooth  Scrapers. 


358  OPEEATIONS    ON    THE    DIGESTIVE    APPARATUS. 

If  several  teeth  are  loose,  and  their  loss  is  thi-eatened,  the  bet- 
ter course  in  regard  to  their  extraction  will  be  to  remove  them 
singly,  and  not  all  at  the  same  time,  lest  a  serious  hemorrhage 
might  supervene,  v^hich  might  even  endanger  the  animal's  life. 

OPEEATIONS  ON  THE  TONGUE. 

The  pathological  lesions  to  which  this  member  of  the  digestive 
apparatus  is  subject,  and  which  may  require  surgical  interference, 
are  principally  wounds  and  tumors,  the  former  demanding  either 
sutures  or  amputations  of  the  organ,  partial  or  complete.  The 
latter,  however,  present  a  greater  variety  of  indications,  according 
to  the  nature  of  the  neoplasm  with  which  the  organ  may  be  af- 
fected. Wounds  of  the  tongue  are  quite  frequent,  but  the  most 
common  are  probably  those  of  the  lacerated  kind,  though  again, 
they  may  be  the  result  of  contusion,  incision,  or  may  even  be  caused 
by  burns. 

Produced  generally  by  self-inflicted  bites,  caused  by  falling, 
or  during  epileptic  seizures,  they  are  usually  made  by  the  incisors. 
A  badly  made  bit,  or  a  halter  or  rope  tightly  binding  the  mouth 
and  pressing  down  the  tongue,  may  also  jjroduce  a  bruise,  or  even 
a  complete  laceration  of  the  organ.  They  are  also  not  uncom- 
monly seen  as  the  result  of  bites  inflicted  by  one  animal  upon  an- 
other, placed  in  an  adjoining  stall,  when  the  separation  between 
them  has  been  insufficient.  In  these  cases,  not  only  a  portion  of 
the  tongue,  but  often  also  the  frsenum  may  be  more  or  less  lacer- 
ated— a  condition  which  may  also  take  place  when  the  tongue 
has  been  puUed  out  by  an  assistant,  a  groom  or  other  person,  and 
the  horse  rebelling,  pulls  back  violently  and  suddenly.  Against 
such  opposite  forces  the  soft  structure  of  the  fraenum  readily 
gives  away.  The  burnt  wound,  or  scalding  of  the  tongue,  may 
arise  from  the  administration  of  a  drench  not  sufficiently  cooled,  or 
of  too  irritating  a  nature.  The  common  way  of  steaming  horses 
with  bran  heated  with  boiling  water,  is  also  an  occasional  cause. 

Injuries  such  as  these  are  generally  easily  detected,  present- 
ing, as  they  do,  a  series  of  symptoms  which  may  properly  be 
called  general.  Difficulty  in  eating,  and  a  more  or  less  abun- 
dant flow  of  stringy  saliva,  which  also  may  be  mixed  with  blood, 
is  apt  to  be  among  the  signs.  In  relation  to  the  special  char- 
acters, noticeably,  there  may  be  in  one  case  a  protrusion  of  the 


OPERATIONS  ON  THE  TONGUE.  359 

tongue  out  of  the  mouth,  with  perhaps  a  drawing-  of  the  organ  to 
one  side,  or  it  may  be  pressed  between  the  incisors  and  hanging 
more  or  less  outside  of  the  buccal  cavity.  In  opening  this 
cavity,  the  tongue  may  then  be  seen  to  be  lacerated  at  its  free 
portion,  the  laceration  being  transversal  or  longitudinal,  complete 
or  incomplete,  and  varjdng  in  dimensions,  from  a  small  portion  of 
the  organ  nipped  from  the  main  body,  to  nearly  the  entire  portion 
in  front  of  the  fraenum.  If  the  antei'ior  portion  is  missing,  the 
fraenum  may  be  seen  in  its  normal  condition,  or  again  may  be  exten- 
sively torn,  in  which  case  the  tongue  is  commonly  hanging  out  of 
the  mouth.  If  the  laceration  is  complete,  the  part  in  front  of  the 
cut  may  have  dropped  outside  and  fallen  into  the  bedding  of  the 
animal,  or  of  the  one  next  to  him,  both  stalls  being  more  or  less 
spattered  with  blood  from  the  hemorrhage  which  has  accom- 
panied the  injury. 

In  cases  of  burns,  the  tongue  pi'esents  all  the  symptoms  of 
glossitis,  it  is  swollen,  its  epithelium  readily  peels  oft',  the  saliva- 
tion is  abundant,  and  the  mouth  heated  and  sore. 

Considered  from  one  point  of  view,  the  prognosis  of  lacerated 
wounds  of  the  tongue  is  not  serious,  there  being  but  few  forms  of 
that  injury  which  are  not  more  or  less  amenable  to  treatment.  The 
nature  of  the  prognosis  varies,  of  course,  with  the  extent  of  the 
wound,  the  depth  of  the  tissue  which  it  involves,  and  the  amount 
of  substance  already  lost  or  requiring  removal.  A  complete 
section  is  always  a  serious  matter,  especially  in  herbivorous 
animals,  by  which  the  tongue  is  so  largely  employed,  and  so  ef- 
ficient, as  an  instrument  for  the  prehension  of  food,  as  well  as  for 
aiding  in  its  mastication,  by  keeping  it  in  contact  with  the  grind- 
ers dui'ing  the  process  of  chewing. 

In  carnivorous  animals,  as  in  dogs,  we  have  seen  the  complete 
sloughing  of  the  free  portion  attended  with  such  difficulty  in  eat- 
ing, that  the  destruction  of  the  patient  became  necessary  in 
order  to  avert  his  death  by  starvation. 

In  almost  all  conditions  of  laceration  of  the  free  portion  of  the 
tongue,  there  is  an  indication  of  an  attempt  to  effect  the  union  of 
the  divided  parts,  and  our  experience  has  led  us  to  the  conclusion 
that  no  one  is  justified  in  refusing  to  treat  a  wound  of  the  tongue 
or  abandoning  such  a  case  without  at  least  an  effort  to  save  it, 
even,  as  in  some  cases,  where  the  divided  parts  are  held  together 
by  the  smallest  portion  of  substance. 


360  operations  os  the  digestive  appakatus. 

Suture. 

It  is  only  by  suture  tliat  the  attempt  can  be  successfully 
made.  Peuch,  Toussaint  and  Zundel  advise  the  throwing  of  the 
horse,  but  we  prefer  the  standing  position  for  the  operation. 
The  instruments  necessary  are  strong  needles  for  metallic  sutures, 
and  soft,  pliable  lead  wire.  We  jDref er  this  kind  of  suture  as  being 
less  liable  to  cut  through  the  muscular  structure  of  the  organ 
and  having  less  tendency  to  give  way.  Having  carefully  washed 
the  surfaces  of  the  lingual  wound,  we  aj^ply  an  interrupted 
suture,  varying  the  number  of  stitches,  according  to  the  extent  of 
the  laceration,  and  prefer  the  interrupted  to  the  continued  suture 
for  the  reason  that  if  one  stitch  fails  to  hold,  it  can  be  easily  re- 
placed by  another.  The  important  point  is  to  secure  a  thorough 
hold  for  each  stitch,  or  in  other  words,  to  involve  a  good  portion 
of  the  tongue  in  the  stitch  on  each  edge  of  the  wound. 

Wounds  of  the  frsenum  need  no  special  treatment,  but  there  is 
an  indication  which  by  its  application  greatly  facilitates,  though 
indu'ectly,  the  cicatrizing  process  of 
Villi]  il     ll^lil  'I'^i/ y^      ^^^  ^^°  parts.     It  consists  in  placing 
l\\    W'il''fj'|'|"' '  Ys|/^         the  tongue  in  a  muslin   suspensory, 
""^  '       ^  having  the  shape  of  the  free  portion 

I  1  of  the  tongue,   and  sewed  together 

V     ^         '    '    -]     ■         on  a  part  of  their  circumference,  leav- 
''-  -  ^  ing  an  opening  for  the  organ  to  enter. 

V-  This  suspensory  is  kept  in  place  by 

^^><3.«.^  ^^^  strings  attached  to  the  halter  on 

Fig.  361.— Tongue  Suspensory.  each  side  of  the  cheeks.  The  use  of 
this  easily  made  apphance  has  given 
us  great  satisfaction,  not  only  in  keeping  the  tongue  in  the  mouth, 
but  also  in  limiting  the  movements  of  the  organ,  and  preventing 
the  giving  way  of  stitches.  The  suspensory  is  to  be  taken  off 
two  or  three  times  a  day,  and  washed,  or  changed  for  another, 
but  must  be  kept  in  place  as  long  as  this  condition  of  the  patient 
requu-es  it.  The  mouth  is  to  be  kept  clean  by  antiseptic  astrin- 
gents and  cooling  gargles,  by  means  of  a  syringe  or  an  irrigator. 
The  use  of  peroxide  of  hydrogen  has  given  us  excellent  results  in 
these  cases.  Nocard  recommends  the  application  of  a  muzzle 
upon  the  patient's  nose,  to  prevent  the  prehension  of  fibrous 
food,  keeping  the  mouth  closed,  and  restricting  the  movements  of 


OPERATIOXS  ON  THE  TONGUE.  361 

the  jaws.  During-  the  treatment  the  animal  is  to  be  fed  with 
liquid  or  semi-liquid  food,  as  mashes  and  gruels  of  all  kinds,  with 
teas,  milk,  etc.  It  is  only  when  the  stitches  are  all  united 
that  the  animal  can  be  brought  by  degrees  to  its  ordinary  diet. 
After  several  days  the  sutiu-es  can  be  removed. 

Amputation,  ok  Glossotomy. 

When  the  sutures  have  failed,  or  when  the  peduncle  which 
holds  the  divided  portions  of  the  tongue  together  is  too  small  to 
permit  the  j^rocesses  of  circulation  and  nutrition  to  go  on,  the  in- 
dications are  to  amjjutate  the  part  of  the  tongue  below  it.  This 
is  done  with  the  scissors ;  the  hemorrhage  that  may  follow  is  sel- 
dom serious,  and  soon  ceases  spontaneously,  or  yields  to  the  use 
of  hemostatics.  Sometimes,  instead  of  direct  amputation,  or  in 
order  to  avoid  the  hemorrhage,  the  removal  of  the  divided  portion 
is  effected  with  an  elastic  ligature — a  mode  of  treatment  also  com- 
monly used  for  the  removal  of  lingual  tumors.  The  ecraseur  has 
also  been  recommended,  on  account  of  the  absence  of  hemorrhage 
attending  its  use.  The  animal  whose  tongue  has  been  amputated 
eats  slowly  and  with  difficulty.  His  prehension  of  hquids  is  also 
necessarily  interfered  with.  It  requires  time  and  practice  for 
him  to  acquire  facility  in  performing  the  old  functions  with 
curtailed  means. 

Adenotomy, 

This  operation  consists  in  the  dissection  and  removal  of  such 
of  the  glands  as  are  accessible  and  amenable  to  that  method  of 
treatment,  including  the  lymphatic  and  salivary,  and  is  described 
as  parotidian  or  maxillary,  as  one  gland  or  the  other  becomes  the 
subject  of  operation.  The  extirjDation  of  these  organs  is  indica- 
ted by  pathological  changes  occurring  in  their  structure,  as  in 
cases  of  chronic  infiltration  following  a  suppurative  process,  as 
seen  in  the  lymphatic  glands  of  the  inter-maxillary  space  after 
strangles,  and  again  when  they  become  the  seat  of  scirrous  de- 
generation, or  of  melanotic  deposits,  or  in  cases  of  salivary  fistula 
complicated  with  loss  of  substance  of  the  excretory  ducts. 

Parotidian  adenotomy  is  a  very  delicate  operation,  and  has, 
therefore,  been  but  seldom  attempted.  To  Leblanc,  in  1822,  is 
due  the  record  of  its  first  performance,  and  of  the  advantages 
attending  it.     A  reference  to  Figures  396  and  397,  which  show 


362  OPEKATIONS    OX    THE    DIGESTIVE    APPARATUS. 

both  the  superficial  and  the  deej)  anatomical  structures  of  that 
region,  will  at  once  suggest  the  difficulties  to  be  encountered  in 
the  numerous  and  imj)ortant  blood  vessels,  which  must  be  either 
avoided  or  ligatured,  and  the  important  nerves  which  must  be 
saved  According  to  Brogniez,  the  operation  is  fully  justified  bv 
its  results,  and  possesses  an  undeniable  claim  to  admission  into 
the  domain  of  authorized  veterinary  surgery.  After  Leblanc,  it 
was  performed  by  Brogniez,  Vanhaelst,  Delwart,  Barlow  and  Per- 
civall. 

The  Traite  de  Chirurgie  Veterinaire  furnishes  the  following 
description  of  the  manual  execution  of  parotid  adenotomy  :  "  The 
animal,  being  well  prepared,  is  thrown,  with  the  parotid  region 
of  the  side  on  which  he  lies  resting  on  a  small  bundle  of  straw,  in 
order  to  render  the  gland,  which  is  to  be  operated  upon,  more 
prominent,  and  the  hair  being  clipjoed,  a  long  incision  is  made  in 
the  direction  of  the  organ,  ^iz.,  from  the  antei'ior  part  of  the  base 
of  the  ear  down  to  below  the  glosso-facial  branch  of  the  jugular  vein. 
This  first  incision,  it  may  be  remarked,  must  be  made  more  to  the 
anterior  border  of  the  gland,  which  is  strongly  adherent  to  the 
maxillary  bone,  as  weU  as  to  the  blood  vessels  and  nerves  j^assing 
that  point,  and,  if  necessary,  a  second  incision  can  be  made  be- 
hind the  first  and  perjDendicular  to  its  lower  extremity.  The  skui 
being  dissected  from  the  whole  extent  of  the  gland,  the  beginning 
of  the  separation  of  the  organ  is  made  near  the  facial  nerve,  from 
thence  gradually  working  downward.  The  lower  extremity  of  the 
gland  is  isolated,  and  after  it  the  posterior  border,  to  terminate 
by  the  suj)erior  extremity,  which  surrounds  the  concha — in  other 
words,  without  reference  to  the  muscular  layer  that  covers  it,  or 
to  some  little  glandular  masses  which  are  isolated  from  the  prin- 
cipal mass,  nor  even  to  its  central  portion  situated  under  the  fa- 
cial branch  of  the  jugular  vein ;  the  gland  being  thus  separated 
is  removed  in  its  whole  circumference.  After  ligating  the  blood 
vessels  which  may  have  been  opened,  the  woimd  is  dressed  and 
closed  with  quill  sutures.  Suppuration  is  soon  established,  the 
granulations  raj^idly  develop  themselves,  and  the  cicatrization  is 
soon  accomplished." 

The  most  serious  complication  usually  met  with  is  the  section 
of  the  facial  and  sub-zygomatic  nerves,  which  is  followed  by  par- 
alysis of  the  face  and  lips  on  that  side.  Director  Degives  divides 
the  operation  into  three  steps.      The  first  includes  the  incision 


OPERATIONS  ON  THE  TONGUE.  363 

and  dissection  of  the  sJcin.  The  incision  is  made  lengthwise,  from 
the  base  of  the  ear  down  to  the  middle  of  the  external  face  of  the 
gland,  that  is,  as  far  as  below  the  glosso-facial  vein,  and  involving 
the  skin  and  the  parotido-auricularis  muscle,  the  dissection  of  the 
skin  being  made  a  little  beyond  the  borders  and  extremities  of 
the  skin.  The  dissection  of  the  gland  forms  the  second  step,  and 
must  be  as  complete  as  possible.  There  are  some  parts  where 
the  gland  is  difficult  to  isolate,  especially  at  the  base  of  the  ear, 
at  its  masseterine  adhesions  near  the  sub-zj^gomatic  blood  vessels 
and  nerves,  but  at  these  points  some  little  glandular  granulations 
may  be  left.  In  this  dissection  the  use  of  the  fingers  or  of  the 
duU  end  of  the  handle  of  a  dissecting  scalpel  is  recommended  in 
order  to  avoid  the  blood  vessels  and  nerves  which  are  so  intimately 
connected  with  the  organ. 

Beginning  with  the  ligation  and  section  of  the  posterior  auric- 
ular vein,  the  anterior  border  of  the  gland  is  isolated  from  above 
downward,  carefully  avoiding  the  sub-zygomatic  blood  vessels 
and  nerves,  after  which  the  jugular  vein  is  isolated  in  the  whole 
extent  of  its  parotid  com'se,  and  the  gland  divided  into  two  por- 
tions, one  above,  the  other  below  the  vein.  The  dissection  of  the 
upper  portion  is  made  from  below  upward,  avoiding  first,  four  ar- 
terial divisions,  including  the  external  carotid,  the  temporal  trunk, 
the  internal  maxillary,  and  the  posterior  auiicular ;  second,  the 
superficial  temporal  and  the  facial  nerves  ;  and  third,  the  guttural 
pouch,  which  is  intimately  adherent  to  the  internal  face  of  the 
gland  above.  The  smaller  arterial  branches  that  are  divided  are 
Hgated  or  twisted.  The  lower  portion  is  then  carefully  dissected 
from  above  downward.  The  dressing  of  the  looimd,  which  is  the 
third  step,  is  performed  according  to  the  process  of  Brogniez. 

Maxillary  Adenotomy. 

AYe  find  but  a  single  description  of  this  operation,  which  is  by 
Director  Degives  in  his  Manuel  de  Medecine  Operatoire  Veteri- 
naire.  Kecommendiag  it  only  as  the  last  treatment  in  the  re- 
fractory fistula  of  Warthon's  duct,  he  first  divides  the  skin  and 
the  cutaneous  muscle  against  the  inferior  border  of  the  gland, 
parallel  to  the  glosso-facial  vein,  and  makes  an  incision  about  four 
inches  long,  which  brings  him  to  the  loose  and  abundant  cellular 
tissue  which  surrounds  the  gland.     The  dissection  is  made  -oath 


364  OPERATIONS    ON    THE    DIGESTIVE    APPARATUS. 

the  fingers  by  tearing  the  connective  tissue  in  the  middle  part 
of  the  gland  ;  when  taking  hold  of  it  at  that  place  it  can  be  care- 
fully pulled  out,  the  division  of  the  cellular  tissue  which  holds  it 
being  easily  detached  with  the  fingers  or  a  blunt  instrument.  The 
position  of  the  woimd  is  such  that  no  special  dressing  is  indicated, 
suppuration  having  a  free  exit. 

OPERATIONS  ON  THE  (ESOPHAGUS. 

The  surgical  affections  which  require  interference  with  the 
oesophagus  and  adjacent  regions  are  classified  as  follows:  Bruises, 
wounds,  lacerations,  ruptures,  tumors,  jabot,  obstruction  by  for- 
eign bodies  or  alimentary  masses,  and  strictures.  The  various 
operations  of  direct  aj^plication  which  are  indicated  in  connection 
with  these  casualties  are:  Catheterism  of  the  oesophagus,  the 
taxis,  the  crushing  of  the  foreign  bodies,  and  oesophagotomy.  This 
classification,  arranged  by  Peuch  and  Toussaint,  meets  with  our 
acceptance,  including  the  operations  enumerated,  and  in  our  con- 
sideration of  the  subject  we  shall,  for  the  present,  refer  our 
readers  for  descriptions  of  the  various  forms  of  disease  to  the 
standard  authorities  upon  veterinary  medicine,  especially  includ- 
ing in  the  hst  the  excellent  work  of  Professor  Williams. 

Before  entering  upon  a  description  of  these  operations,  a  re- 
view of  the  surgical  anatomy  of  that  organ  will  be  in  place. 

The  oesophagus  is  a  long  musciilo-mucous  canal,  which  at  the 
third  stej)  of  deglutition  carries  the  food,  both  liquid  and  sohd, 
from  the  pharynx  to  the  stomach.  Stretched  between  these  two  or- 
gans, it  successively  occupies  the  neck  down  its  inferior  region,  the 
entire  length  of  the  thorax,  and  a  small  portion  of  the  abdomen. 
At  its  origin  (Fig.  362),  situated  on  the  median  line,  it  communi- 
cates with  the  pharynx  by  an  opening  above  the  glottis;  from 
thence  it  runs  obliquely  downward,  from  before  backward,  be- 
hind the  ti-achea,  until  about  the  middle  of  the  neck,  where  it 
begins  to  deviate  to  the  left,  resting  from  thence  on  that  side  of 
the  trachea.  In  this  situation  it  enters  the  thorax,  to  resume  its 
former  position  on  the  trachea;  passes  above  its  bifurcation  and 
the  base  of  the  heart,  running  through  the  layers  of  the  posterior 
mediastinum,  which  covers  it,  reaches  the  right  pillar  of  the  dia- 
i:»hragm,  and  passes  through  it,  and  entering  the  abdomen,  has  its 
termination  on  the  left  side  of  the  small  curvature  of  the  stomach. 


OPERATIONS   OK    THE    tESOPHAGUS. 


3G5 


Fig.  362,— Anatomy  of  the  CEsophagus  and  Jugular  Vein  of  the  Horse.  J  J,  jugular 
vein ;  C,  carotid  artery ;  O  U,  suh-scapulo  hyoideus  muscle ;  D,  cBSophagus ;  S,  sterno- 
maxillaris  muscle ;  M,  mastoido-humeralis  muscle. 

The  relations  of  the  oesophagus  must  then  be  considered  accord- 
ing to  its  divisions  of  the  cervical,  thoracic  and  abdominal  portion. 
At  its  point  of  origin,  at  the  pharynx,  it  is  situated  between  the 
larynx  and  the  guttural  pouches.  In  the  upper  half  of  the  neck  it 
is  in  relation,  in  front,  with  the  trachea;  behind,  with  the  long 
muscle  of  the  neck;  and  on  the  side  with  the  car.  tid  and  its 
/satellite  nei-ves.  Below  this  point,  and  as  it  deviates  to  the  left, 
it  is  related  to  the  left  side  of  the  trachea,  upon  which  it  rests, 
and  on  its  outside,  with  the  scalenus  muscle,  the  carotid  artery  and 
the  jugular  vein.  In  a  very  few  instances,  instead  of  passing  to 
the  left  of  the  trachea,  it  deviates  to  the  right,  but  otherwise  holds 
the  same  relations  as  when  in  its  normal  position.  At  its  entrance 
into  the  thorax,  the  oesophagus,  still  on  the  side  of  the  trachea, 
corresponds  outwardly  with  the  inferior  cervical  ganglion  and  its 
branches,  and  to  the  vertebral,  superior  cervical  and  dorsal  arteries 


366  OPERATIONS    ON    THE    DIGESTIVE    APPARATUS. 

and  veins,  whicli  cross  its  course  and  further  back,  returning  be- 
tween the  trachea  and  the  longus  coDi,  it  passes  over  the  left  bron- 
chia and  to  the  right  of  the  thoracic  aorta.  Beyond  this,  placed 
between  the  folds  of  the  posterior  mediastinum,  it  is  received 
into  the  groove  of  the  internal  face  of  the  lungs,  with  the  oesoph- 
ageal arteries  and  nerves.  Passing  through  the  opening  of  the 
right  pillar  of  the  diaphragm,  we  find  it  in  its  abdominal  portion 
related  on  the  right  to  a  notch  of  the  superior  border  of  the  Hver, 
and  ending  at  the  cai'diac.  The  structure  of  the  oesophagus  is 
formed  of  two  coats ;  one  of  external  and  muscular,  the  other 
of  internal  and  mucous  membrane.  The  external  is  composed 
of  muscular  fibers,  spiral,  red  and  longitudinal,  striated  in 
its  anterior  three  quarters,  and  white  in  the  posterior  quarter. 
Anteriorly,  the  crico-pharyngeus  furnishes  it  with  a  sort  of  cii'cu- 
lar  necktie.  Towards  its  posterior  portion,  the  muscular  coat  is 
much  thicker  than  in  the  other  parts,  and  as  it  passes  through  the 
pillars  of  the  diaphi-agm,  it  is  more  or  less  pressed  upon.  These 
three  points  must  be  remembered,  inasmuch  as  they  serve  to  ex- 
plain the  resistance  which  is  encountered  by  instruments,  such 
as  the  catheter,  or  the  probang,  when  introduced  into  its  cavity. 
The  internal  coat  or  mucous  membrane  is  whitish,  with  longi- 
tudinal folds,  which  are  so  developed  at  the  cardia  that  they  may 
resist  the  passage  of  the  probang  into  the  stomach. 

(Esophageal  Catheterism 
is  an  operation  consisting  in  the  introduction  of  a  special  instru- 
ment, soHd  or  hoUow,  but  always  flexible,  into  the  cavity  of  the 
oesophagus,  either  to  remove  bodies  that  obstruct  it,  or  to  aid  the 
exit  of  gases  which  have  accumulated  in  the  stomach. 

It  is  therefore  indicated  in.  three  principal  conditions,  viz.: 
first,  tym2)anitis  in  ruminants ;  second,  in  cases  of  oesophageal 
dilatation,  ox  jabot ;  and  third,  to  dislodge  foreign  bodies  arrested 
in  its  canal. 

In  cases  of  tyinpanitis,  it  is  of  advantage  if  the  trouble  is  not 
too  far  developed,  and  danger  of  suffocation  not  too  imminent. 
In  cases  of  oesophageal  jabot,  due  to  a  more  or  less  extensive 
dilatatiou  of  the  organ,  in  consequence  of  the  lodgment  and 
packing  of  food,  it  is  in  many  instances  of  but  very  little  benefit. 
"When  foreign  bodies  are  lodged  in  the  oesophagus,  an  accident 
to  which  horses  are  liable,  and  which  is  very  common  in  cattle 


OPERATIONS    ON    THE    (ESOPHAGUS. 


3G7 


and  in  dogs,  it  is  often  of  great 
advantage.  The  oj)eration  would 
naturally  depend  very  largely  for 
its  success  upon  the  size  of  the 
foreign  body,  which  of  course  is  a 
variable  cii-cunistance,  and  also  on 
the  condition  of  its  external  sur- 
face, whether  rough  or  smooth,  or 
having  projecting  points;  depend- 
ing much  likewise  on  the  situation 
in  the  length  of  the  canal,  and 
whether  it  has  become  engaged  in 
the  cervical  or  the  thoracic  portion 
of  the  passage. 

Probangs  for  the  throat  and  a 
speculum  for  the  mouth  are  instru- 
ments necessary  for  this  operation. 

There  are  various  forms  of  pro- 
bangs,  the  designs  of  different  in- 
ventors. The  first,  which,  accord- 
ing to  Brogniez,  was  invented  by 
Monro  of  Edinburgh,  has  been 
more  or  less  perfected.  The  pro- 
bang  of  Baujin  (Figure  363)  is  re- 
versible, and  may  be  so  adjusted 
as  to  either  push  down  or  extract 
the  ofiending  substance  from  its 
place  of  lodgment.  The  instru- 
ment in  ordinary  use  is  designed 
essentially  to  push  the  obstruction 
thi'ough  the  passage.  It  is  found 
in  all  our  surgical  instrument  ma- 
kers' shops,  and  is  made  of  whalebone  or  of  rubber,  separable  in 
two  parts,  connected  by  a  screw.  One  end  (Fig.  304)  has  a  bulb- 
ous enlargement,  the  other  a  blunt  mass  or  head,   made   concave 


Fig.  363.— Baujin's  Probang. 


Fig.  364.— Ordinary  Whalebone  Probang. 


368  OPEEATIONS    ON    THE    DIGESTIVE    APPARATUS. 

on  its  free  end,  the  better  to  act  without  slipping  against  the  ob- 
ject with  which  it  is  to  come  in  contact.  The  probang  of  the 
stomach  pump  forms  an  excellent  instrument  for  that  purpose. 

Dr.  Peabody  has  constructed  a  simple  implement  of  strong, 
thick  wire,  twisted  together  and  forming  a  rod  of  sufficient  length, 
protected  by  a  tube  of  India  rubber,  and  having  one  end  formed 
into  a  ring  or  loop,  to  serve  as  a  handle,  while  at  the  other  ex- 
tremity a  sponge  of  suitable  size  is  secured  and  formed  into  a 
bulb  resembling  that  of  the  ordinary  probang.  Degives  recom- 
mends for  use  in  cases  of  emergency  an  extemporized  instrument, 
formed  of  a  whip  handle  or  a  branch  of  a  tree,  of  sufficient 
length,  of  the  size  of  the  little  finger,  with  a  bulb  composed  of  a 
ball  of  oakum  covered  with  cloth.  This  "bulb  is  attached  to  the 
end  with  strong  twiue,  of  which  a  free  end  is  left  of  equal  length 
with  the  instrument,  in  order  to  draw  out  the  broken  fragments 
in  case  of  fracture  of  the  probang. 

Whatever  form  of  probang  may  be  used,  it  is  always  neces- 
sary to  associate  with  it  a  speculum  to  keep  the  mouth  sufficiently 
open   and  immobile.     Those   which   are  recommended  and  em- 


FlG.  .365.— Brogniez's  Gag. 

ployed  in  the  exploration  of  the  mouth  are  available  for  this  pur- 
pose. But  as  these  are  not  always  obtainable,  some  ingenious  and 
simple  apparatus  can  be  made  at  a  moment's  notice  like  that  illus- 
trated in  Figure  365,  which,  or  something  equivalent,  ought  to  be 
mthin  the  scope  of  the  inventive  and  constructive  capacity  of  any 
weU  equipped  surgeon. 


OPERATIONS    ON    THE    (ESOPHAGUS.  369 

In  ruminants  the  operation  is  performed  in  the  standing  posi- 
tion, "svith  the  head  extended  and  elevated  on  the  neck.  In  soli- 
peds  it  cannot  be  performed  except  while  the  animal  is  down,  and 
when  the  head  can  be  placed  in  the  proper  position  of  extension 
to  allow  the  instrument  to  pass  beyond  the  elbow  formed  by  the 
pharynx  and  the  oesophagus.  The  animal  being  in  position,  and 
the  speculum  adjusted,  an  assistant  draws  the  tongue  out  of  the 
mouth,  and  the  operator,  placed  in  front  of  his  patient,  passes  the 
probang  through  the  opening  of  the  speculum,  and  rapidly  pushes 
it  into  the  mouth,  resting  it  upon  the  hard  palate,  in  order  to  pre- 
vent its  being  displaced  laterally  by  the  motion  of  the  tongue.  At 
the  bottom  of  the  mouth  the  jorobang  meets  with  some  Httle  re- 
sistance at  the  soft  palate,  but  the  instrument  soon  reaches  the 
fauces,  in  the  phar;^Tix,  and  penetrates  the  oesophagus.  At  this 
moment  possibly  some  resistance  may  be  encountered,  owing  to 
the  contraction  of  the  crico-pharjmgeus  muscle,  but  once  engaged 
in  the  oesophagus  the  instrument  readily  passes  the  proj)er  dis- 
tance downwards,  according  to  the  requirements  of  the  case.  If 
the  object  in  view  is  to  relieve  tjanpanitis,  and  a  true  catheter, 
tube,  or  stomach  pump  or  hollow  probang  has  been  used,  the 
gases  will  find  a  means  of  exit  as  soon  as  the  instrument  has 
penetrated  the  stomach. 

If  the  catheterism  has  been  performed  for  the  displacement  of 
foreign  bodies,  the  resistance  they  offer  to  the  pressure  of  the 
probang  must  be  overcome  by  a  steady,  and,  at  times,  quite  a 
powerful  pressure  of  the  instrument,  caution  being  always  neces- 
sary to  avoid  causing  laceration  of  the  wall  of  the  passage.  ^Vhen 
the  obstruction  is  even  but  slightly  loosened,  its  complete  dis- 
lodgment  often  follows  from  the  mere  unassisted  contraction  of 
the  cesoiDhageal  muscles.  Caution  and  gentleness  must  not  be 
overlooked  even  in  the  mere  withdrawal  of  the  probang.  It 
should  be  practiced  as  a  maxim,  indeed,  that  whatever  instrument 
may  be,  for  any  purpose,  made  use  of,  not  alone  in  the  proj)ulsion 
of  the  intruding  body  in  these  cases,  the  operator  must  never  re- 
mit his  caution  and  gentleness,  nor  lose  sight  of  the  fact  of  the 
natural  Habihty  to  accident  always  accompanying  surgical  in- 
terference with  the  organs  and  tissues  having  theii-  place  in  the 
interior  regions  of  the  animal  organism,  and  not  cognizable  by 
the  eye.  Serious  accidents  have  been  recorded  as  resulting  from 
a  lack  of  care  and  attention  in  the  manner  of  withdi-awing  the  in- 


370  OPEBATIONS   ON    THE    DIGESTIVE    APPARATUS. 

strument.  Lacerations  of  the  oesophageal  walls,  rupture  of  blood 
vessels,  perforation  of  the  trachea,  abscesses  of  the  mediastines, 
pleurisy  and  pericarditis  belong  to  the  list  of  recorded  casualties 
in  this  connection.  To  facilitate  the  working  of  the  probang,  in 
these  cases,  certain  practitioners  have  recommended  the  adminis- 
tration of  oil  or  mucilaginous  drenches. 

The  Taxis. 

The  oesophageal  catheterism  which  we  have  just  considered  is 
principally  applicable  to  cases  where  the  obstruction  is  in  the 
thoracic  portion  of  the  passage.  When  it  is  in  the  cervical  por- 
tion, instead  oi  pi'opulsion  or  intra^yulsion,  it  is  by  extraindsion., 
or  by  the  course  of  the  natural  passages  that  the  foreign  body  is 
to  be  removed.  In  this  case  the  taxis  is  made  to  take  the  place 
of  the  ordinary  artificial  appliances,  and  the  hands  become  the  in- 
struments with  which  the  surgeon  seeks,  by  making  forcible  and 
methodical  pressure,  to  move  the  impacted  object  back  into  the 
mouth. 

In  1820,  Delafoy  recommended  a  process  which  is  to-day  ad- 
mitted to  be  one  of  the  best  modes  of  reheving  cattle  when  suf- 
fering with  this  difficulty,  and  many  other  methods  have  since 
then  been  devised,  but  most  of  them  are  merely  modified  plans  of 
Delafoy's  method.  We  shall  consider  them  as  briefly  as  possible. 
In  order  to  raise  the  iinpac.t  (as  we  shall  for  convenience  call  it) 
back  into  the  pharynx,  Delafoy  has  the  animal  thrown,  on  the 
right  side,  and  administers  a  glass  of  sweet  olive  oil,  and  while 
an  assistant  steadies  the  oesophagus,  applies  with  his  fingers  upon 
the  impact,  a  retrograde  motion  which  carries  it  upward,  back 
and  to  the  pharjnix.  When  it  reaches  that  cavity,  the  head  is 
raised,  the  jaws  are  opened  with  a  speculum,  and  the  operator, 
passing  his  hand  through  that  instrument  into  the  back  of  the 
mouth,  seizes  the  impact  and  brings  it  away.  Lindenberg  keeps 
the  patient  on  his  feet  instead  of  casting  him,  but  otherwise  ob- 
serves the  same  modus  operandi.  Denenbourg  operates  with  his 
patient  in  a  standing  position.  While  an  assistant  holds  the 
head,  well  extended,  and  elevated  on  the  neck,  he  places  himself 
on  the  right  side  of  the  animal,  and  with  the  fingers  pressing  be- 
low the  impact  (like  Delafoy),  displaces  it  and  gives  it  the  as- 
cending motion  which  transfers  it  to  the  pharynx,  and  keeps  it 
there  by  pressing  hard  below  it.     Then  putting  an  assistant  in  his 


OPERATIONS    ON    THE    (ESOPHAGUS.  371 

place  lie  proceeds  like  the  others  to  remove  the  impact  with  the 
hand  passed  through  the  speculum. 

Schaack  operates  also  in  the  standing  position,  the  hind  legs 
being  hobbled  above  the  hocks,  the  head  is  kept,  as  much  as  pos- 
sible, in  a  horizontal  position,  and  a  si^eculum  placed  in  the 
mouth.  The  operator  takes  his  place  on  the  left  side,  in  front  of 
the  shoulder,  the  right  hand  on  one  side  of  the  neck,  the  left  on 
the  other.  If  the  impact  is  rather  low  down,  or  near  the  chest, 
the  extremities  of  the  fingers  are  brought  together  and  employed 
to  push  it  upward,  with  careful  manipulations.  If  it  is  situated 
higher  up,  near  the  oesophagus  where  it  is  less  surroimded  by 
muscles,  the  pressure  is  made  with  the  fingers  closed.  In  either 
case,  however,  when  it  has  reached  the  throat,  Schaack  holds  it 
there,  while  an  assistant  with  his  hand  boldly  introduced  into  the 
mouth,  seizes  it  and  draws  it  out  of  the  pharynx. 

According  to  Peuch  and  Toussaint,  Mr.  G.  Tisserand,  in  cases 
of  jabot,  operates  as  follows :  Making  a  point  of  support  on  the 
neck  with  the  right  hand,  with  the  left  he  violently  shakes  the 
part  where  the  projection  of  the  jabot  is  most  prominent,  and 
then  applies  alternate  movements,  up  and  down,  with  a  lateral 
shaking  of  the  enlargement  until  the  patient  voluntarily  lowers 
his  head,  and  as  he  snuffles  throws  out  through  the  nostrils  and 
the  mouth,  abundant  mucosities,  mixed  with  alimentary  detritus. 
If  the  first  manipulations  fail,  Tisserand  advises  the  occasional  ad- 
ministration of  mucilaginous  decoctions,  or  oil,  or  even  plain  water. 

The  method  of  Martin  is  one  which  is  also  held  in  high  esteem, 
and  at  the  hazard  of  needless  repetition  and  unnecessary  minutiae 
we  give  it  in  detail.  Instead  of  extending  the  head,  which  has  a 
tendency  to  stretch  the  oesophagus  and  diminish  its  diameter,  he 
keeps  the  head  of  the  patient  low  down,  at  about  a  foot  from 
the  ground,  and  placing  himself  on  the  left  side  of  the  neck,  he 
passes  his  right  arm  over  the  neck,  in  such  a  manner  that  envelop- 
iag  the  neck  between  both  arms,  his  hands  can  join  on  the  lower 
border  of  the  neck,  and  both  thumbs  pressed  in  the  jugular 
grooves,  one  on  the  right,  the  other  on  the  left.  It  is  by  succes- 
sive pressures  from  behind  forward,  that  he  succeeds  in  pushing 
the  impact  iu  the  pharynx.  Then  comes  a  peculiar  step  of  the 
operation :  As  by  its  presence  the  soft  palate  closes  somewhat  the 
posterior  opening  of  the  mouth,  the  impact  cannot  re-enter  this 
cavity,  and  thus,  while  the  mass  is  in  the  pharynx  and  resting  on 


372  OPKRATIONS    OX    THE    DIGESTIVE    APPARATUS. 

the  posterior  face  of  the  vekmi  palati,  with  both  thumbs  he  pushes 
it  from  above  downward  and  from  behind  forward;  the  effect 
of  this  is  to  depress  the  base  of  the  tongue,  and  to  enlarge  the 
isthmixs  of  the  throat  sufficiently  for  the  impact  to  pass  through 
it,  back  in  the  mouth,  and  drop  it  to  the  ground.  If,  however,  the 
pressure  required  in  this  step  of  the  operation  could  not,  for  one 
reason  or  another,  such  as  excessive  thickness  of  the  lower  border 
of  the  neck,  for  instance,  be  maintained,  then  the  impact  is  ex- 
tracted with  the  hand. 

Courioux  has  advised  the  application  of  a  cord  around  the 
neck,  below  the  impact  to  be  moved  upwards  with  it,  as  the  dis- 
placement is  accomplished.  The  object  of  this  is  to  retain  what- 
ever progress  may  be  gained  by  preventing  the  mass  from  re- 
ceding again.  It  forms  a  substitute  for  the  fingers  in  holding  it 
in  position. 

The  extraction  by  the  mouth  of  many  substances  arrested 
in  the  oesophagus  has  also  been  effected  with  instruments. 
Forceps  long  and  curved,  hooks  and  hollow  sounds,  having  metal- 
lic nippers  or  jaws,  like  that  of  Baujin,  have  been  recommended. 
That  of  Wegerer  is  probably  entitled  to  the  highest  commenda- 
tion of  all.  But  with  all  theii-  ingenuity  and  perfection  their  use 
is  not  mthout  danger  of  causing  lacerations  of  the  oesophageal 
walls,  and  they  are  constant^  liable  to  get  out  of  order. 

Ceushing  the  Foreign  Body. 

At  times  the  obstruction  takes  place  in  the  cervical  portion  of 
the  oesophagus,  and  attempts  to  displace  it,  either  toward  the 
mouth  or  the  stomach,  have  failed.  To  meet  this  emergency 
various  means  have  been  sought  for,  either  to  crush  the  impact,  or 
cut  it  in  small  pieces.  One  suggestion  for  the  first  object  is  to 
break  it  with  blows  of  a  maUet,  a  piece  of  wood,  or  other  object 
held  by  an  assistant,  furnishing  the  point  of  resistance.  But  this 
is  obviously  a  dangerous  process,  nearly  certain  to  produce 
bruises  and  lacerations  of  the  soft  structures,  with  probably  sub- 
sequent gangrene.  At  best  it  can  be  available  only  when  the  im- 
pact is  in  the  form  of  a  comparatively  soft  mass,  such  as  ripe  fruit 
or  the  like. 

Professor  Lafosse  had  in  1846  suggested  subcutaneous  incis- 
ion, and  this  was  put  in  practice  in  1855  by  Chapard  for  the  relief 
of  a  cow  choked  by  a  piece  of  a  beet.     A  simple  puncture  of  the 


OPERATIONS    ON    THE    CKSOPHAGUS.  373 

oesopliagiis  was  first  made,  with  a  straight  tenotome,  below  the 
obstruction,  then  a  curved  tenotome  was  introduced  through  the 
wound,  and  by  careful  movements  in  the  mass  of  impact,  it  was 
sufficiently  divided  to  enable  it  to  resume  its  usual  course  down- 
ward into  the  rumen.  Though  this  mode  of  operation  has  not 
become  established  in  general  practice,  the  application  of  its  prin- 
ciple has  not  been  overlooked,  and  has  not  been  without  its  influ- 
ence in  simplifying  the  performance  of  the  operation  of  oesopha- 
gotomy. 

CESOPHAGOTOMY. 

When  the  obstruction  is  in  the  cervical  portion  of  the  oesopha- 
gus, and,  either  because  of  its  nature  or  of  its  form,  cannot  be 
displaced  by  any  of  the  means  we  have  discussed,  the  division  of 
the  organ  itself  furnishes  the  only  escape  from  the  consequences 
of  the  difficulty.  The  operation  of  oesophagotomy  consists  in  the 
exposure  of  the  oesojohagus  and  the  incision  of  its  walls.  While 
it  is  usually  performed  for  the  removal  of  obstrvicting  bodies,  it  is 
also  indicated  in  some  cases  as  a  mode  of  facilitating  the  adminis- 
tration of  drugs,  or,  under  special  circumstances,  of  food  and 
drinks. 

It  is  of  French  origin,  and  its  adoption  in  veterinary  surgery 
seems  to  have  occurred  in  1782,  when  it  was  performed  by  Lom- 
pagieu  Lapole  to  remove  an  orange,  arrested  in  the  inferior  region 
of  the  neck.  Since  that  epoch  it  has  been  performed  on  horses, 
cattle,  dogs,  and  even  on  swine.  Damoiseau,  Felix,  Michel  and 
others  have  performed  it  on  cattle ;  Thissine,  H.  Bouley,  Keynal, 
Rey,  Marrel,  Mauri  on  the  horse;  Peuch,  Macgillivray,  Williams, 
on  dogs,  and  Lagrange  on  pigs.  H.  Bouley  performed  it  to  re- 
move a  piece  of  corncob  and^  a  large  molar  tooth  which,  after  ex- 
traction, had  slipped  into  the  CBSophagus;  Baldwin  extracted  a 
large  piece  of  a  root;  Rey  removed  a  cork;  Peuch  took  away 
pieces  of  bone  from  a  dog.  In  fact,  the  operation  has  generally, 
if  not  exclusively,  as  is  but  natural,  been  appropriated  to  the  relief 
of  patients  laboring  under  the  difficulty  we  have  been  discussing. 
A  claim  has  been  made  in  its  behalf  as  a  means  of  rehef  in  lock- 
jaw, by  facilitating  the  artificial  feeding  of  the  sufi'erer.  But  such 
a  claim,  as  to  any  practical  value  which  may  be  supposed  to  attach 
to  it,  cannot  in,  anywise  possess  any  validity,  nor  be  to  any  extent 
sustained  when  we  take  into  consideration  the  history  and  the 


374  OPERATIONS    ON    THE    DIGESTIVE    APPAEATUS. 

nature  of  tetanus  and  its  origin,  with  tlie  complications  and  con- 
sequences likely  to  accompany  and  to  follow  it.  Marrel  lias  rec- 
ommended it  in  cases  of  fractures  of  tlie  jaws;  but  sucli  practice 
would  truly  furnish  an  example  of  the  proverbial  case  in  which 
the  remedy  is  worse  than  the  disease  It  has  also  been  recom- 
mended for  the  relief  of  jabot,  and  has  been,  in  some  cases,  fol- 
lowed by  favorable  results. 

The  instruments  necessary  for  this  operation  are  a  convex  and 
a  straight  bistoury,  a  pair  of  dissecting  forceps,  a  director,  a  needle 
and  strong  thread ;  to  these  may  be  added  a  pair  of  scissors  and 
two  blunt  tenaculums,  with  also  large  forceps  to  grasp  the  impact 
and  extract  it,  close  at  hand.  The  animal  must  be  kept  in  the 
standing  position,  and  held  under  thorough  control  by  an  assist- 
ant, with  a  twitch  on  the  lower  lip  or  on  the  ear,  and  either  fore 
foot  raised  or  both  fore  legs  hobbled. 

It  must  be  taken  into  consideration  that  the  cervical  jDortion 
of  the  oesophagus  is  situated  immediately  behind  the  trachea,  con- 
tinuing thence  as  far  as  the  middle  of  the  neck,  when  it  deviates 
to  the  left,  where  it  occupies  the  lower  third  of  the  neck ;  and 
again,  that  this  cervical  region  is  surrounded  by  an  abundance  of 
loose  connective  tissue,  having  on  each  side  the  carotid  and  its 
nerves.  It  will  also  be  observed  that  the  lower  third  of  the  neck 
forms  a  triangular  space,  with  above  it  the  inferior  border  of  the 
sub-scapulo-hyoideus  muscle,  and  on  the  sides  the  sterno-maxil- 
laris,  levator-humeri  and  scalenus.  In  this  space  it  is  in  connec- 
tion on  the  inside  \\dth  the  trachea,  upon  which  it  rests ;  and  on 
the  outside  with  the  scalenus,  the  carotid,  the  jugular  and  the 
nerves  of  that  region — organs  which  are  aU  covered  by  the  cuta- 
neous colli  and  the  skin. 

The  point  of  separation  of  the  middle  and  lower  third  of  the 
neck,  in  the  left  jugular  groove,  is  the  'place  of  election  or  of  ne- 
cessity for  the  operation,  or  where  the  incision  of  the  skin  must 
begin,  a  httle  above  and  behind  the  jugular.  If  the  obstruction 
is  considerably  prominent,  this  incision  must  be  made  directly 
over  it. 

Peuch  and  Toussaint,  in  their  excellent  work,  divide  the  oj)er- 
ation  into  three  steps,  which  they  thus  describe : — 

1st.  Step.  Incision  of  the  skin  and  dissection  of  the  subja- 
cent tissues. — Standing  on  the  left  side,  the  operator  first  deter- 
mining the  situation  of  the  jugular  vein,  clips  the  hair  from  over 


OPERATIONS    ON    THE    (ESOPHAGUS. 


375 


the  tumor,  stretches  the  skin  with  the  left  thumb  and  index 
finger,  and  with  the  convex  bistoury,  extends  the  incision  from 
the  initial  point,  about  four  fingers'  breadth  do^NTi,  parallel  with 
the  blood  vessels.  The  incision  divides  the  skin,  and  the  cuta- 
neous muscle,  and  exposes  the  jugular  and  carotid  and  their  nerves. 
The  thumb  of  the  left  hand  is  then  introduced  into  the  incision 
and  depresses  forward  the  blood  vessels  and  nerves,  while  the 
other  fingers  of  the  same  hand  are  embracing  the  tracheal  border 
of  the  neck.  The  oesophagus  is  thus  exposed  on  the  lateral 
border  of  the  trachea,  and  the  cellular  tissue  which  covers  the 
organ  is  then  divided.  By  raising  the  upper  lip  of  the  incision 
with  a  blunt  tenaculum  the  oesophagus  may  be  still  more  exposed. 
2d  Step.  Loosening  or  isolation  of  the  oesophagus — Cutting 
away  part  of  the  cellular  tissue,  the  cesophagus  is  seized  with 
the  thumb  and  index  of  the  right  hand  and  drawn  outward.  The 
vascvdo-nervous  fasciculus  are  then  let  loose,  the  cesophagus  is 


Fig.  366.— The  (Esophagus  Drawn  Outward  and  liaised  with  the  Scissors. 


37G  OPEKATIONS    OX    THE    DIGESTIVE    APPARATUS. 

di-awn  out  Avitli  tlie  left  hand,  tile  right  holding  the  curved  scis- 
sors, which  being  jDassed  from  above  downward,  and  separating 
the  remaining  portion  of  cellular  tissue,  holds  the  organ  resting 
upon  its  blades,  in  readiness  for  the  third  step  (Fig.  366). 

3d  Step,  or  Incision  of  the  cjesophagus. — The  operator  then, 
supporting  the  scissors  with  the  oesophagus  resting  upon  them, 
in  the  left  hand,  with  a  straight  bistoury  with  the  edge  tuimed 
upward,  in  the  right,  makes  a  large  puncture  in  the  oesophageal 
walls,  passing  through  their  entire  thickness,  and  afterwards  en- 
larging it  with  the  aid  of  a  director.  At  this  point  of  the  operation, 
and  at  each  deglutition,  there  is  usually  an  escape  of  mucosities 
mingled  with  food.  "WTien  the  impact  forms  a  decided  projection, 
the  incision  should  be  made  directly  over  the  prominence. 

Professor  Nocard  has  modified  the  operation  in  cases  where 
the  obstruction  can  be  di^'ided  in  small  pieces,  by  making  only  a 
correspondingly  small  incision.  He  uses  both  a  straight  and  a 
curved  tenotome,  and  performs  the  first  and  second  steps  as  in 
the  preceding  methods,  the  third  one  being  made  as  follows: 
"The  oesophagus  being  exposed,  isolated  and  placed  over  the 
scissors,  the  operator  introduces  the  straight  tenotome  through 
the  oesoi:)hageal  membranes,  the  blade  running  parallel  with  the 
muscular  fibers,  into  the  thickness  of  the  impact  (apple,  potatoe, 
pieces  of  beet,  etc..)  avoiding  injury  to  the  opposite  surface  of  the 
canal;  then  sHding  the  curved  tenotome  against  the  straight  one, 
and  pushing  it  through  the  entire  mass  until  it  touches  the  op- 
posite wall  of  the  oesophagus,  he  withdraws  the  straight  instru- 
ment, and  divides  the  impact  by  movements  of  the  curved  instru- 
ment, analogous  to  those  made  in  the  division  of  the  tendons  in 
the  operation  of  plantar  tenotomy.  The  blunt  end  of  the  curved 
tenotome  protects  the  oesojDhagus  from  any  enlargement  of  the 
original  wound." 

Cagny,  after  exposing  the  oesophagus,  as  already  described, 
crushes  the  obstruction  by  rejDeated  gentle  blows  of  a  small 
mallet,  as  before  described.  He  prefers  this  mode  to  that  of  in- 
cision if  the  impact,  though  hard  and  flat,  possesses  but  little  force 
of  adhesion.  ^\Tien  the  objects  of  the  cesophagotomy  have  been 
reahzed,  there  is  no  necessity  for  fm'ther  interference,  the  appli- 
cation of  sutures  being  generally  considered  rather  injurious  than 
otherwise,  and  though  the  resulting  wound  is  of  a  somewhat  com- 
pHcated  nature,  its  perfect  cicatrization  in  a  comparatively  short 


GASTEOTOMY.  377 

time  is  the  general  nile.  The  principal  indication  is  cleanliness  in 
the  removal  of  the  discharges,  and  of  any  mncosities  or  food  that 
may  escape  over  its  surfaces.  H.  Bouley  has  experimentally 
proved  that  to  obtain  the  cicatrization  of  oesophageal  wounds  it  is 
essential  "■to  feed  the  animals  loith  food  of  fibrous  texture,  and 
nothing  hut  pure  water  to  drink."'  By  respecting  this  indication 
all  danger  of  complications  is  avoided. 

The  possible  accidents  and  complications  ai*e:  xoounds  of  the 
blood  vessels  during  the  first  steps  of  the  operation,  but  the 
hemoiThage  that  f oUows  may  be  stopj^ed  by  pressure  or  ligature ; 
iedeinatous  sicelling  of  the  w^ound,  suggesting  the  infiltration  of 
food  or  pus  in  the  surrounding  cellular  tissue.  It  may  terminate  in 
a  simple  abscess,  or  it  may  be  the  precursor  of  a  fatal  gangrenous 
complication:  purulent  infection,  seiyticmmia,  tetanus,  are  also 
possible  sequelse  of  oesophagotomy,  but  a  faithful  and  judicious 
application  of  antiseptic  means  in  dressing  and  nursing  the 
patients  wiU.  usually  baffle  the  possible  evil. 

GASTEOTOMY— EUMENOTOI^IY. 

This  title,  in  our  opinion,  ought  to  include  the  puncture  or  in- 
cision of  the  rumen,  when  designed  to  liberate  confined  gases  or 
to  remove  the  solid  contents  which  may  have  accumulated  in  that 
viscerse.  In  the  first  case  it  is  indicated  when  the  tympanitic 
condition  of  the  first  compartment  of  the  stomach  exhibits 
alarming  symptoms  and  resists  all  ordinary  remedial  indications ; 
and  in  the  second,  when  the  gases  of  the  rumen  are  mixed  with 
the  aHmentary  mass  contained  in  that  organ  and  a  larger  opening 
than  that  made  by  the  trocar  becomes  necessary,  for  their  re- 
moval. In  either  case  the  left  flank  must  be  the  seat  of  election 
for  the  operation,  the  rumen  occupying  that  side  of  the  abdomen, 
and  situated  at  a  point  equally  distant  from  the  last  rib,  the 
angle  of  the  ilium  and  the  transverse  process  of  the  lumbar 
vertebrae.  Tabourin  suggests  the  last  intercostal  space  as  the 
proper  place  for  the  operation.  The  instruments  necessary  are  a 
large  trocar  (Fig.  367)  with  a  straight  and  a  curved  bistoury.  The 
gastrotomes  invented  by  Brogniez  (Fig.  3G8)  and  Sajoux  are  too 
complicated.     The  animal  must  be  in  the  standing  position. 

Puncture  of  the  mmen. — The  operator,  facing  the  left  flank, 
makes  an  incision  throuj^h  the  skin,  about  an  inch  and  a  half  lonq-, 


378  OPERATIONS    ON    THE    DIGESTIVE    APPARATUS. 


Fig.  367.— Large  Trocars. 

with  the  bistoury,  or  with  the  blade  of  a  lancet.  Then  placing 
the  trocar  perpendicularly  upon  the  flank  and  into  the  cutaneous 
incision,  presses  it  against  the  muscles,  and  with  his  right  hand 
strikes  a  heavy  blow  on  the  handle  of  the  instrument  and  forces 
it  into  the  cavity  of  the  rumen,  jorovided  the  blow  has  been  suffi- 
ciently heavy.  The  blade  of  the  trocar  is  then  withdrawn,  the 
canula  being  left  in  place,  and  the  gases  allowed  to  escape,  as 
in  the  operation  of  enterotomy. 

Incision  of  the  rumen. — The  oj^erator,  using  a  convex  bistoury, 
makes  an  incision  in  the  middle  of  the  left  flank,  beginning  a  httle 
below  the  point  selected  for  the  j)uncture  of  the  rurhen,  and 
measuring  a  length  of  from  three  to  four  inches,  cuts  through 
and  divides  the  entire  thickness  of  the  skin,  and  the  walls  of  the 
rumen.  The  hand  is  then  introduced  and  employed  for  the  re- 
moval of  the  food  contained  in  the  cavity.  The  further  cleaning 
out  of  the  rumen  may  be  done  with  a  large  spoon.  Schaack 
recommends  the  removal  of  only  a  hmited  portion  of  the  ferment- 
ing mass,  and  that  the  walls  of  the  organ  should  not  be  scraped. 

While  the  puncture  of  the  rumen  does  not  require  to  be  fol- 
lowed by  any  special  subsequent  treatment,  the  wound  of  the  in- 
cision needs  to  be  closed  immediately  after  the  removal  of  the 
contents  of  the  organ.  This  must  be  attended  with  every  anti- 
septic precaution,  and  the  closing  be  done  by  means  of  the  inter- 
rupted suture.  The  parts  shovild  be  thoroughly  cleansed.  Adhe- 
sion may  be  promoted  by  the  application  of  a  wide  band  of  ad- 
hesive plaster  placed  all  roimd  the  animal,  as  recommended  by 
Professor  Brush  of  the  American  Veterinary  College.  The  wound 
of  the  puncture  heals  rapidly,  while  that  of  the  iucision  requires 
from  a  week  to  ten  days,  and  if  properly  treated,  unites  by  the 
first  intention,   without  suj)puration.     The  accidents  which   are 


GASTEOTOMY. 


379 


piQ.  368 -Brogniez's  Gastrotome. 


t~:;Cr" J':— a«veV..e.  t.e,e.to.t. 
generally  iDroves  fatal. 


380  OPERATIONS    OX    THE    DIGESTIVE    APPARATUS. 


ENTEEOTOMT. 

The  division  or  punctm-e  of  the  intestines,  or  enterotomy, 
is  an  operation  the  object  of  which  is  to  facilitate  the  exit  of  gases 
contained  in  these  organs,  to  prevent  their  excessive  dilatation, 
and  to  obviate  certain  too  commonly  fatal  comphcations.  It  was 
mentioned  at  an  early  day  by  Vegetius,  especially  in  connection 
with  the  treatment  of  wind  cohcs,  but  not  again  spoken  of  imtil 
1776,  when  Koem,  Bomvinghausen,  and  at  a  later  date,  Barrier 
and  Herouard  obtained  good  results  from  it.  Bourgelat  and 
Chabert  recommended  it  in  the  early  stages  of  the  disease,  but, 
notwithstanding  the  favorable  dicta  of  all  these  authorities,  the 
operation  was  not  fully  admitted  to  a  place  in  the  domain  of 
veterinary  surgery  until  Bernard,  Dieterichs,  Falke,  Key,  Schaack, 
HajTie,  Eckel,  Blendeiss,  Charlier  and  others,  had  proved  by  nu- 
merous facts  that  when  performed  under  favorable  circumstances 
it  is  not  orJy  harmless,  but  is  capable  of  insuring  results  of  the 
most  beneficial  character. 

Intestinal  puncture  is  indicated  in  cases  of  tympanitis  or  flat- 
ulent cohc,  due  to  indigestion,  or  to  an  intestinal  obstruction, 
and  must  be  performed  whenever  the  accumulation  of  gases  has 
resisted  ordinary  forms  of  treatment.  The  indication,  in  our  opin- 
ion, is  to  operate  early  in  the  disease,  as  an  almost  positive  means 
of  avoiding  the  complications,  or  rupture  of  the  stomach  or  lacera- 
tion of  the  intestines,  which,  if  unchecked,  may  accompany  the  flatu- 
lent accumulation.  Enterotomy  is  also  recommended  in  cases  of 
strangulated  hernia,  when  the  gases  which  are  imprisoned  in  the 
hernial  intestines  j^revent  its  reduction.  Imbert  used  it  with  ad- 
vantage in  reducing  a  strangulated  ventral  hernia.  In  former 
days  Chabert  performed  the  operation  through  the  rectum,  and 
Abadie,  in  1875,  reported  a  case  in  which  he  reached  the  intes- 
tines through  the  vagina.  But  while  it  may  be  possible  to  ob- 
tain access  to  the  dilated  intestines  through  these  channels,  it 
is  e^^dent  that  it  is  a  method  which  must  oppose  more  difficul- 
ties and  involve  more  comphcations  than  the  puncture  through 
the  flank. 

The  point  of  selection  for  the  operation  is  about  the  center  of 
the  space  formed  forward  by  the  border  of  the  last  rib,  behind  by 
the  external  angle  of  the  ihum,  and  above  by  the  extremity  of  the 


ENTEKOTOMY. 


381 


Fig.  369.— Trocars  for  the  Coecum. 


Fig.  370.— Brogniez's  Enterotome. 


transverse  processes  of  the  lumbar  vertebrae,  on  the  right  flank — 
since  it  is  there  that  the  dilatation  of  the  intestines  is  most  prom- 
inent. The  puncture,  if  made  at  this  stated  point,  penetrates  the 
second  portion  of  the  large  colon ;  if  it  is  made  nearer  the  lumbar 
vertebrae,  it  enters  the  arch  of  the  ccecum. 

The  only  instrument  necessary  to   perform  enterotomy  is  a 
trocar.     The  instrument  used  in  cattle  for  puncture  of  the  rumen 


382  OPERATIONS    ON    THE    DIGESTIVE    APPARATUS. 

was  formerly  employed,  but  it  is  quite  unnecessary  and  of  no  ad- 
vantage to  use  a  canula  of  such  dimensions  merely  to  allow  the 
escape  of  the  gases.  A  small,  round  trocar  is  now  in  general  use, 
and  is  in  our  estimation  to  be  preferred  to  the  ordinary  flattened 
form  of  instrument  (Fig.  369).  The  enterotome  of  Brogniez  (Fig. 
370)  is  too  large  an  instrument,  and  its  use  endangers  the  walls 
of  the  intestines  and  the  siuTounding  blood  vessels. 

Brogniez  reports  a  case  of  injury  to  one  of  the  coecal  arteries 
by  the  point  of  this  instrument.  We  have  frequently  had  re- 
course to  the  trocar  of  the  epidermic  syringe  used  for  horses, 
when  no  other  instrument  was  conveniently  at  hand. 

The  animal  suffering  with  flatulent  colics  is  treated  while  on 
its  feet,  and  the  pain  it  endures  is  usually  of  so  intense  a  kind 
that  no  means  of  restraint  are  necessary,  and  it  remains  per- 
fectly indifferent  to  the  insignificant  and  minor  pang  of  the  oper- 
ation. The  principal  caution  to  be  observed,  is  to  be  on  guard 
against  the  patient's  suddenly  falling,  but  if  this  should  occiu-  it 
need  not  interrupt  the  operation,  which  may  be  continued  with- 
out forcing  it  to  rise. 

The  modus  oj^erandi  is  very  simple.  The  spot  being  acurately 
determined,  the  point  of  the  instrument  is  pressed  perpendicu- 
larly upon  the  skin  with  one  hand,  and  di'iven  by  a  strong,  quick 
blow  with  the  other  upon  the  handle,  through  the  skin  and  the  in- 
testinal coats  into  the  visceral  cavity.  The  withdrawal  of  the  rod, 
leaving  the  canula  in  place,  completes  the  process,  by  giving  vent 
to  the  gases.  These  escape  with  more  or  less  force,  as  announced 
by  a  whistling  sound  as  they  pass  out  of  the  tube.  The  intestines 
must  then  be  entered  from  above  downward,  and  not  as  recom- 
mended by  Hertwig,  who  punctures  the  most  dependent  part  of 
the  abdomen,  and  thus  exposes  his  patient  to  serious  subcutaneous 
infiltrations. 

Peuch  and  Toussaint  suggest  the  propriety  of  making  a 
small  preparatory  incision  through  the  skin  with  a  bistoury,  pre- 
vious to  the  main  punctui'e  with  the  trocar.  The  escape  of  the 
gases  continues  for  a  varying  time,  according  to  the  amoimt  of 
the  accumulation.  The  instrument  should  continue  in  the 
wound  while  the  escape  continues,  and  until  the  tympanitic  con- 
dition of  the  intestines  disappears.  If  the  escape  of  gas  should 
suddenly  cease,  it  will  be  because  the  canula  is  filled  with  fcecal 
or  other    matters,  and  the  trocar  must  be  re-inserted  into  its 


PAKACENTESIS. 


383 


canula  until  the  renewed  escape  of  the  gas  proves  that  the  ob- 
struction has  been  removed.  If,  however,  they  still  fail  to  find  an 
exit  through  the  canula,  a  second  puncture  must  be  made  at  a 
short  distance  from  the  first.  The  wound  of  the  puncture  re- 
quu-es  no  treatment. 

According  to  Zundel,  enterotomy  is  comparatively — in  ordin- 
ary cases — harmless;  still,  however,  complications  more  or  less 
severe  are  possible,  and  have  been  observed.  Hemorrhages, 
though  of  no  alarming  nature,  have  been  noticed,  and  several 
cases  of  abscess  have  been  recorded,  either  at  the  seat  of  the 
operation,  or  at  the  wound  of  the  flank,  and  even  in  the  groin. 
Peritonitis  has  also  been  encountered.  Subcutaneous  emphysema 
has  been  mentioned  by  Bouley ;  but  in  an  experience  of  many 
years,  we  have  never  seen  it.  Laceration  of  the  floating  colon  has 
been  reported  by  Schaack.  As  a  means  of  prevention  against 
these  accidents  we  would  recommend  great  care  in  the  introduc- 
tion of  the  trocar  through  the  abdominal  walls,  and  especially  a 
condition  of  thorough  cleanliness,  with  a  careful  disinfection,  of 
the  instrument. 

PAEACENTESIS. 

This  term,  with  its  synonyms  of  puncture  and  tapping,  is  at 
the  present  time  applied  exclusively  to  the  operation  performed 
upon  the  abdominal  waUs  for  the  purpose  of  evacuating  the  seros- 
ity  collected  in  the  peritoneal  cavity,  as  the  result  of  dropsical  ef- 
fusion. It  consists  in  puncturing  the  abdominal  walls  in  the  man- 
ner practiced  in  enterotomy  and  gastrotomy.  The  operations  are 
similar,  while  the  purpose  varies  materially  in  the  several  cases. 

This  operation  had  ah-eady  been  recommended  by  Vegetius — 
afterward  employed  by  Vitet,  as  a  last  resort  in  ascitis.  Lafosse, 
Jr.,  also  speaks  of  it,  and  in  more  modern  times  we  find  it  advo- 
cated by  St.  Cyr,  Lafosse,  Forster  and  others.  Though  in  the 
majority  of  cases  forming  only  a  palliative  treatment,  it  is  never- 
theless indicated  in  chronic  dropsy  of  the  abdomen,  when  all 
other  forms  of  treatment  have  failed  to  produce  the  resorption  of 
the  fluid,  especially  when  its  accumulation  interferes  with  the  ab- 
dominal and  thoracic  functions.  In  these  cases  of  ascites  it  has 
been  performed  upon  horses,  cattle  and  dogs.  The  injection  of 
tincture  of  iodine  into  the  peritoneal  cavity,  after  the  removal  of 


384 


OPERATIONS    ON    THE    DIGESTIVE    APPARATUS. 


the  effusion,  has  been  successfully  added  as  a  means  of  preventing- 
the  return  of  the  fluid. 

In  selecting  the  place  where  the  operation  is  to  be  performed, 
Brogniez,  Degives,  Peuch  and  Toussaint  ad\ised  the  middle  of 
the  hnea  alba,  at  an  equal  distance  from  the  xiphoid  cartilage  of 
the  sternum  and  the  anterior  border  of  the  pubis ;  Zundel,  on  the 
contrary,  recommends  "  a  puncture  on  the  right  side  in  ruminants, 
on  the  left  in  horses,  on  a  point  at  an  equal  distance  between  the 
umbilicus  and  the  external  angle  of  the  ilium,  about  on  a  line  run- 
ning from  the  stifle  towards  the  cartilage  of  the  last  rib."  He 
adds,  however,  "to  select  the  point  where  the  liquid  is  most  de- 
tectable and  fluctuation  better  felt." 

A  trocar  of  the  size  of  a  quiU  for  large  animals,  and  an  aspirator 
for  the  smaU,  are  the  only  instruments  required.  In  operating  on 
large  animals,  they  are  kept  standing,  while  small  animals  are  laid 
upon  a  table  and  placed  slightly  on  their  backs.  Placing  himself 
on  the  left  side  of  the  animal,  after  having  selected  the  place 
where  the  puncture  is  to  be  made,  the  operator,  holding  the  trocar 


Fig.  371.— Holding  the  Trocar  in  Paracenthesis. 


full  in  his  hand  and  limiting  its  action  by  keeping  his  fingers  a 
short  distance  from  the  point  of  the  instrument,  jjushes  it  by  a 
rapid  and  firm  pressure  through  the  thickness  of  the  abdominal 
waUs,  until  he  feels  that  he  has  overcome  their  resistance,  and  that 
the  instrument  has  passed  into  the  cavity.  The  trocar  is  then 
withdrawn  from  its  canula  and  the  fluid  escapes  through  the  tube. 
Director  Degives  describes  another  modus  operandi,  which  he 
calls  subcutaneous,  in  which  the  opening  of  the  skin  does  not  cor- 
respond with  the  division  of  the  deeper  muscular  layers,  and  by 
which  the  opening  becomes  covered  by  the  skin.  To  effect  this 
the  skin  is  drawn  a  little  aside,  then  punctured,  or  a  large  fold  of 
the  tegument  is  taken  hold  of,  and  the  puncture  made  at  its  base. 
In  either  case,  when  the  skin  is  loosened,  its  retraction  comjjletely 
closes  the  abdominal  opening. 


HEKNIA.  385 

If  tlie  escape  of  the  fluid  shoiild  stop  or  diminish,  a  blunt 
stylet  can  he  introduced  into  the  canula  to  clean  it  of  any  albu- 
minous or  epiploic  mass  which  may  obstruct  it.  The  operation  in 
small  animals  is  performed  in  the  same  manner. 

As  the  removal  of  the  entire  accumulation  of  the  fluid  is  dan- 
gei'ous,  though  less  so  than  in  thoracentesis,  it  is  better  to  permit 
a  portion  of  it  to  remain.  The  quantity  is  sometimes  enormous, 
ranging  between  thirty-five  and  ninety-six  quarts.  After  the 
quantity  desired  has  been  obtained,  the  canula  of  the  trocar  is 
carefully  withdrawn,  and  a  bandage  or  roller  of  adhesive  plaster 
placed  aroimd  the  body  of  the  animal. 

Among  accidents  possible  in  this  operation,  wounds  of  blood- 
vessels or  of  the  intestines,  and  fatal  peritonitis  may  be  men- 
tioned. 

HERNIA. 
General  View. 

In  a  general  sense,  any  tumor  formed  by  the  entire  or  partial 
escape  and  j)rotrusion  of  an  organ,  either  wholly  or  in  part,  from 
the  restraining  tension  of  the  integuments,  or  from  the  cavity 
which  forms  its  normal  location,  is  a  hernia,  or  in  popular  phrase, 
a  rupture.  The  more  special  appHcation  of  the  term  is  to  the  dis- 
placement of  the  abdominal  viscera,  but  it  is  also  employed  to 
describe  the  enceplialocele,  or  protrusion  of  the  brain  through  the 
cranium;  the  projection  of  the  iris  and  \h.Q jabot,  or  protrusion  of 
the  oesophagal  mucous  membrane,  through  its  muscular  covei'ings. 
And  again  the  prominence  of  a  synovial  membrane  beyond  its 
ordinary  bounderies:  that  of  a  muscle  through  its  aponeurotic 
envelope ;  the  prolapsus  of  the  rectum ;  of  the  vagina ;  of  the 
uterus,  etc.,  etc., — these  also  receive  the  same  designation  and  are 
recognized  members  of  the  hernia  family.  We  shall,  in  the  pres- 
ent chapter,  mainly  limit  our  consideration  to  the  disjjlacements  of 
the  abdominal  digestive  organs. 

The  rationale  of  the  formation  of  a  hernia  becomes  a  matter 
of  easy  comprehension,  when  we  take  into  consideration  the  gen- 
eral anatomy  of  the  abdomen,  and  especially  the  structure  of  its 
inferior  wall.  The  muscular  layers  which  form  the  exterior  wall 
of  this  large  splanchnic  canity  are  not  of  equal  density  through 
their  whole  extent,  and  consequently  do  not  offer  in  every  part  an 
equal  amount  of  resistance  to  the  outward  pressure  of  the  interior 


386 


OPERATIONS    OX    THi:    DIGESTIVE    APPARATUS. 


contents.  In  one  place  muscnlo-carfcilag-inous,  or  bony,  it  is  in 
another,  musculo-aponeurotic.  In  some  parts  protected  by  only  a 
single  layer  of  muscle,  as  in  its  anterior  wall ;  in  others  the  layers 
of  muscular  aponeurotic  structure,  or  of  fibrous  bandages,  are  re- 
inforced by  a  powerful  elastic  band,  as  in  the  inferior  portion,  by 
the  tunica  abdominalis.    But  besides  this  variety  in  the  elements 


Fig.  372.— Muscles  of  the  Inferior  Abdominal  Region. 


1,  aponeurosis  of  the  great  oblique;  2,  fleshy  portion  ol  the  small  oblique;  3,  straight  of 
the  abdomen;  3',  transverse  of  the  abdomen;  4,  pre-pubic  tendon;  5,  inguinal  ring;  6,  its 
anterior  border;  7,  the  posterior;  8,  external  commissure;  9,  internal  commissure; 
10,  posterior  border  of  the  aponeurosis  of  the  great  oblique  ;  11,  internal  crural  aponeu- 
rosis; 1'^,  flap  of  the  aponeurosis  of  the  great  oblique,  drawn  downward  to  show  th'^^ 
origin  of  the  reflex  portion  which  forms  the  crural  arch ;  14,  remains  of  the  umbilicus. 

forming  the  walls  of  the  cavity,  there  is  also  to  be  taken  into  con- 
sideration the  fact  that,  at  certain  points  in  the  walls,  natural 
openings  exist,  and  that  the  abdominal  cavity  is  therefore  not 
strictly  a  close  cavity.  These  passages  consist  of  the  inguino-cru- 
ral  openings,  the  umbihcus  and  those  found  in  the  diaphragm  for 


HERNIA.  387 

the  egress  of  certain  organs  out  of  the  aljclomen,  either  during 
foetal  life  or  after  birth. 

The  hernia,  when  not  arising  from  a  traumatic  cause,  is  the 
result  of  some  violent  muscular  effort  on  the  part  of  the  animal, 
in  the  course  of  which  the  viscera  are  made  to  exert  a  violent  out- 
ward pressure  upon  the  walls  of  the  abdomen.  If  the  pressure 
bears  against  any  of  the  more  solid  portions  of  the  wall,  there  will 
be  no  }delding,  and  the  parts  will  remain  uninjured  and  intact. 
But  if  the  pressure  becomes  unduly  violent,  and  the  attack  is  di- 
rected against  some  one  of  the  weaker  supports,  there  must  be  a 
yielding,  and  the  intestine  or  omentum,  as  the  case  may  be,  will 
be  forced  through  the  oj^ening  which  falls  most  nearly  in  line  with 
the  direction  of  the  violence.  The  resistance  fails,  the  viscera 
passes  through  the  aperture,  and  there  is  a  protrusion,  a  rup- 
ture, a  hernia. 

Two  elements  must  enter  into  the  composition  of  all  hernias, 
with  the  exception  of  eventrations.  They  are  the  sac,  and  the 
displaced  organs  which  form  its  contents,  and  the  mode  of  its 
formation  may  be  readily  comprehended  by  a  consideration  of  the 
figures  373,  374,  375,  Avhich  show  the  progressive  displacement  of 
the  peritoneum,  as  it  is  pushed  through  the  opening  of  the  ab- 
dominal walls,  by  pressure  of  the  intestines,  which  are  also  gradu- 
ally passing  through  the  same  opening.  The  figures  show  in  what 
manner  the  hernial  ox  peritoneal  sac  is  formed. 

The  sac  is  thus  shown  to  be  the  prolongation  of  the  perito- 
neum, which  is  displaced,  moved  and  distended,  or  may  have  sus- 
tained partial  laceration  of  its  fibres.  It  may  even  happen  that 
the  rupture  of  that  serous  membrane  is  complete,  and  that  it  has 
become  lodged  in  the  cellular  tissue.  In  such  a  case  the  lacerated 
peritoneum  soon  throws  out  a  provisional  reparatory  sheath,  which 
becomes  continuous  with  the  natural  serous  membrane. 

Whether  formed  by  the  peritoneum  itself,  or  by  a  membrane  of 
secondary  formation,  the  sac  is  always  composed  of  a  middle  por- 
tion, or  body,  and  an  opening,  or  ring,  which  constitvites  a  means 
of  communication  with  the  abdominal  cavity,  with  a  neck  or  canal, 
a  narrowed  portion,  uniting  together  the  body  and  the  opening  of 
the  tumor. 

But  Httle  uniformity  exists  in  the  formation  of  the  ring  or 
opening  of  a  hernia.  In  some  instances  it  is  round  or  oblong,  in 
others  it  is  a  narrow  slit,  and  again  it  exhibits  a  triangular  outline. 


388 


OPEKATIONS    ON    THE    DIGESTIVE    APPARATUS. 


Fig.  373. 


Explanation.— In  these  three 
figures  an  idea  of  the  mode  of 
formation  of  hernias  is  given: 
aa  aa  aa,  represent  a  section  of 
the  abdominal  wall;  o  o  o,  the 
aponeurotic  opening  through 
which  the  peritoneum,  pjij^PPPi 
is  engaged  to  form  the  hernial 
sac,  s;  the  intestine,  ii  ii  ii,  is 
shown  entering  the  hernial  sac 
gradually. 


In  the  ventral  kind  the  aperture  is  wide  and  of  varying  dimen- 
sions, and  it  may,  moreover,  be  quite  wanting,  or  again,  it  may 
be  long  and  cylindrical,  as  in  inguinal  rupture;  while  in  the  um> 
bihcal  variety  it  is  very  short,  and  represented  merely  by  the 
thickness  of  the  edges  of  the  hernial  ring.  The  body  or  middle 
portion  of  the  intestines,  or  that  which  becomes  lodged  in  the 
cavity  of  the  sac,  also  varies  in  size,  direction  and  form,  and  may 
be  considered  under  the  four  j^rincipal  heads  of  the  cylindrical. 


389 


Fig.  378.— Conical 
Hernial  Sac. 


Fig.  379.— Pyriform 
Hernial  Sac. 


Fig.  380.— Hernial  Sac 
in  Clusters,  or  having 
three  contractions — 
/,  d,  b. 


Figs.  381, 382 ^MultilolDular  Hernial  Sacs. 


390  OPERATIONS    ON    THE    DIGESTIVE    APPARATUS. 

the  spheroidal,  the  convex,  the  i^yriform,  to  which  Zundel  adds 
the  clustered  and  the  multilobular. 

The  relation  as  to  dimensions  between  the  body  of  the  hernia 
and  the  measurement  of  the  ring  is  a  point  of  importance  in  re- 
lation to  estimating  the  more  or  less  serious  nature  of  a  case.  It 
will  readily  be  inferred  that  with  a  narrow  and  contracted  open- 
ing, an  obstruction  may  easily  take  place,  and  at  an  early  date, 
and  that  in  due  time  the  result  will  be  manifested  in  the  legitimate 
form  of  a  strangulation,  an  accident  which  will  be  accompanied 
with  various  phenomena,  according  to  the  degree  of  pressure  and 
the  duration  of  the  period  of  formation,  and  all  of  them  attended 
with  trouble  and  danger. 

At  first,  as  the  capillary  circulation  becomes  retarded  and  diffi- 
cult, the  intestines  assume  a  red  color,  which  passes  successivel}' 
through  many  shades,  from  deep  red  to  brown  or  a  blue-black, 
indicating  the  arrest  of  the  blood,  of  which  the  dreaded  sequel 
may  be  looked  for  in  the  appearance,  a  httle  later,  of  signs  of  mor- 
tification of  the  parts  involved. 

The  blood  then  transudes  through  the  walls  of  its  vessels,  and 
filtrates  into  the  sub-serous  and  sub-mucous  cellular  tissue,  thus 
increasing  the  bulk  of  the  contents  of  the  sac.  At  the  same  time 
the  external  sm-f  ace  of  the  protruding  intestines  becomes  the  seat 
of  what  is  at  first  a  yellowish  exudation,  but  which  becomes  a 
bloody  deposit,  ready  for  organization  if  the  patient  hves  long 
enough  to  survive  the  pains  of  the  strangulation.  By  the  eight- 
eenth or  towards  the  twent^'-fourth  horn-,  however,  signs  of  total 
gangrene  make  then*  appearance  and  the  hernial  portion  becomes 
flabby,  cool,  and  insensible ;  the  odor  becomes  very  offensive,  and 
the  tissues  easily  lacerated  or  torn.  The  fatal  end  is  then  near, 
being  rarely  deferred  beyond  the  twenty-fourth  horn-,  unless  im- 
mediate relief  has  been  interposed. 

But,  of  course,  every  case  does  not  observe  this  regular  succes- 
sion of  symptoms,  nor  reach  the  same  final  termination,  and  in 
the  instances  in  which  the  interference  with  the  cu'culation  is  less 
pronounced  and  the  degree  of  pressure  upon  the  protruding 
organ  is  lighter,  probably  not  more  than  sufficient  to  interfere 
moderately  with  the  movement  of  the  intestinal  contents,  we  have 
a  modified  evil  to  contend  with  in  the  obstruction  or  engorgement 
of  the  hernia,  with  consequences  in  view  less  discouraging  to  con_ 
template      The  exudation  ujDon  the  surface  of  the  contents  of  the 


391 


':V!""m:i<wmiiui:!!:Ui1! 


Fig  383  — StraiU'ii    i  >   I  lnjnm.il  Ht-rnia. 
A,  intestinal  circumvolution.     B.  h,einiittci  iiutioii  of  the  intestine.    D  D,  neck  of 
the  viKinal  sac  compressing  the  intestiiies     E,  internal  wall  of  tlie  vaginal  sac.    T,  tes- 
ticle in  the  fundus  of  tlie  vaginal  sac. 

sac  lias  resulted  in  an  adj^esion  with  the  internal  sm'face,  and  the 
hernia  has  taken  its  place  in  the  class  of  the  irreducible.  Hernias 
of  long  standing,  which  have,  at  intervals,  shown  indications  of 
obstructions,  are,  in  the  greater  number  of  instances,  in  fact,  ir- 
reducible. 

There  are  still,  however,  cases  of  simpler  condition  in  which 
the  viscera  continue  to  be  movable  in  the  sac,  in  which  fact  they 
are  due  to  the  lubricating  effect  of  a  free  serous  exudation. 


392  OPERATIONS    ON    THE    DIGESTIVE    APPARATUS. 

Aside  from  other  distinguishing  characteristics,  all  hernias  are 
divisible  into  two  classes — internal  and  external.  Of  the  latter, 
some,  as  the  eventration,  have  no  containing  sac,  while  the  others, 
which  have  a  serous  covering,  are  in  reahty  alone  entitled  to  be 
considered  as  the  true  hernias.  These,  usually  occurring  through 
one  of  the  natui'al  02)eiiings,  are  called  natural,  in  ojjposition  to 
the  accidental,  which,  like  the  ventral  hernias  and  the  eventration, 
occur  through  accidental  and  artificial  oj)enings.  Any  of  the  ab- 
dominal viscera,  with  the  exception  of  the  pancreas  and  the  kid- 
neys, may  enter  into  the  formation  of  a  hernia,  and  as  each  is 
known  by  the  name  of  the  displaced  organ,  we  are  given  the 
designations  of  enterocele  for  a  hernia  of  the  small  intestines  ;  epi- 
plocele,  for  that  of  the  omentum,  and  entero-epiplocele  of  both  the 
intestines  and  omentum.  The  name  of  g astro-ventral  is  given  to 
the  ventral  hernia  which  involves  with  it  the  stomach ;  cystocele, 
when  it  is  the  bladder  which  is  affected,  and  hysterocele  when  the 
uterus  is  concerned.  Hernias  can  be,  moreover,  congenital  or  oc- 
casional— that  is,  they  may  exist  at  birth  or  previous  to  it,  and 
also  when  making  their  appearance  under  special  causes  after 
birth.  They  may  be  also  considered  as  acute  when  recent,  or 
chronic,  when  of  long  standing. 

Their  originating  causes  are  numerous,  and  may  be  said  to 
comprehend  any  which  may  predispose  an  animal  to  such  a  lesion 
by  contributing  to  an  increase  of  the  pressure  which  the  organs 
contained  in  the  abdominal  cavity  bring  to  bear  upon  its  walls,  or 
any  w^eakness  in  the  walls,  which  may  diminish  their  power  of  re- 
sistance to  the  pressure,  as,  for  example,  a  condition  of  leanness 
arising  from  a  sudden  or  recent  change  from  a  state  of  obesity ; 
blows  upon  the  abdomen  ;  wounds  and  cicatrices  of  the  abdomi- 
nal vfalls  ;  \'iolent,  jerking  efforts,  such  as  those  required  in  com- 
pulsory jumping  or  hauling,  or  in  any  other  of  the  struggles  to 
which  they  are  too  often  forced,  and  even  when  under  the  sur- 
geon's hands,  when,  as  a  j^atient,  the  animal  is  cast  and  secured 
for  an  operation ;  the  rapid  relaxation  after  contraction  of  the 
natural  openings,  repeated  pressure,  or  excessive  dilatation,  as 
with  staUions  used  for  covering  mai*es,  may  be  placed  among  the 
j)redisposing  causes.  They  have  also  been  observed  in  mares, 
after  violent  efforts  during  parturition ;  also  during  colics  and 
other  tympanitis.     To  recapitulate  and  partly  to  rej)eat 

The  general  symptoms  characteristic  of  hernias,  are  compar- 


HERNIA.  393 

atively  easy  to  recognize,  and  can  be  reduced  to  two  principal 
points,  to  wit — the  discovery  of  a  tumor,  and  appearance  of  an 
opening  coexisting  in  the  abdominal  walls.  These  tumors  and 
openings  offer  many  varieties  of  form  and  character.  The  tumor 
located  opposite  to  a  natural  opening,  or  under  a  breach  or  sepa- 
ration in  the  structure  of  the  abdominal  walls,  or  under  a  cicatrix, 
forms  a  mass,  indolent,  elastic,  remittent,  of  varying  size,  but  di- 
minishing or  increasing  under  peculiar  conditions,  such  as  rest  or 
pressure,  and  the  standing,  or  the  lateral  or  recumbent  position, 
etc.,  andha\ang  different  forms,  being  located  in  various  places. 

It  has  also,  in  many  instances,  the  quality  of  being  reducible, 
that  is,  it  may  be  made  to  disappear  by  means  of  certain  manipu- 
lations and  appropriate  treatment,  and  arrangements  of  position, 
to  retui'n  to  their  previous  status  when  these  agencies  are  sus- 
pended; or  again,  they  will  become  permanently  irreducible  under 
special  pathological  changes  already  alluded  to.  The  presence  of 
borborygmus  is  also  an  important  item  among  the  means  of  form- 
ing a  physical  diagnosis  of  these  tumors.  This  is  detected  more 
or  less  readily  when  the  displaced  organ  is  a  portion  of  the  in- 
testines. They  are,  however,  missing  when  the  hernia  is  formed 
by  other  organs,  as,  for  instance,  in  case  of  epiplocele.  Other 
points  connected  with  this  subject  remain  to  be  mentioned. 
Among  these  are  the  final  symptoms,  and  more  or  less  remote  re- 
sults, which  may  follow  the  presence  and  working  of  the  lesion 
upon  the  general  economy  and  the  johysiological  functions  at 
large,  when  the  acute  action  has  passed  away. 

The  constitutional  symptoms^  or  what  may  be  so  denominated, 
will  vary,  in  their  nature  and  their  intensity,  correspondingly  with 
the  condition  of  the  hernia  and  the  compUcations  which  may  ac- 
company each  case.  Among  these  comphcations,  four  principal 
ones  may  be  mentioned  as  taking  precedence : 

1st.  Irreducibility. — This  is  more  frequent  in  old  cases  than 
in  new,  and  is  probably  due  to  the  increase  in  size  of  the  dis- 
placed organ  to  the  degeneration  of  the  tissues,  or  to  old  adhe- 
sions between  the  organ  and  its  covering,  the  sac.  These  cases, 
which  may  be  considered  rather  permanent  than  merely  chronic, 
maintain  their  status,  either  completely  or  partially,  unchanged. 
Yet  they  cannot,  natm-ally  or  rationally,  be  held  to  be  compatible 
with  a  sound  constitution  or  unimpaired  stamina  in  the  animals 
so  conditioned,  and  their  liabihty  to  contract  indispositions  easily 


394  OPERATIONS    ON    THE    DIGESTIVE    APPARATUS. 

has  frequently  been  remarked.  Difficulty  ia  tlie  performance  of 
movements  requiring  effort  has  also  been  noticed,  with  conse- 
quently a  liability  to  suffer  traumatic  injuries  from  external  vio- 
lence.    To  this  must  be  added  a  facility  in  contracting: 

2d.  Inflammation.  —  Generally  this  occurs  as  the  result  of 
external  injuries,  but  it  may  also  occur  without  any  apparent 
cause.  Its  seat  is  the  sac  or  its  contents,  and  it  affects  the  serous 
structures  alone,  or  assumes  a  phlegmonous  aspect.  The  inflam- 
mation of  the  serous  tissue  is  often  overlooked,  while  that  of  the 
phlegmonous  cannot  pass  unobserved.  It  may  sometimes  assume 
a  very  serious  character,  and  become  even  more  dangerous  than 
the  true  strangulation. 

3d.  Obstructions  or  engorgements,  common  in  intestinal  her- 
nias, are  due  to  the  accumulation  of  alimentary  or  stercoraceous 
masses  in  the  displaced  intestines,  or  to  gases  which  interfere 
with  the  reduction  of  the  hernia.  This  is  often  complicated  with 
strangulation,  but  is  not  in  itself  of  a  very  dangerous  natiu*e. 

4th.  Strangulation. — This  condition  has  been  alread}^  consid- 
ered. It  is  the  result  of  excessive  pressure  upon  the  blood 
vessels  of  the  displaced  organ,  and  while  under  its  three  periods 
or  degrees  of  congestion,  inflammation,  and  gangrene,  has  usually 
a  fatal  termination. 

The  general  treatment  of  hernia  has  the  two  objects  in  view  of 
the  destruction  or  obliteration  of  the  sac,  and  the  reduction  or 
closino-  of  the  ring.  If  the  first  is  not  always  easy  to  accomjDUsh 
the  reduction  of  the  diameter  of  the  ring  often  is  so.  Each  form 
of  hernia  demands  some  special  directions  for  the  realization  of 
these  two  objects,  and  these  will  each  receive  its  own  share  of 
attention  as  they  may  in  turn  come  under  our  notice  in  further 
treating  the  various  forms  of  hernia. 

Inguinal  Hernia. 
Inguinal  hernia  results  from  the  passage  or  presence  of  a 
portion  of  the  intestines,  or  of  the  omentum,  or  of  both  together, 
in  the  testicular  or  vaginal  cavity  whose  opening  of  communica- 
tion with  the  peritoneum  or  inguinal  ring  continues  in  its  normal 
condition,  having  never  closed.  A  brief  survey  of  the  general 
anatomy  of  the  region  involved  will  be  a  necessary  preliminary  to 
our  discussion  of  the  subject,  which  is  one  of  interest  and  im- 
portance. 


HERNIA. 


395 


Fig.  384.— Anatomical  Disposition  of  the  Inferior  Inguinal  King  and  Testicular  Sac. 

Explanation  of  Fig.  384.— A  C,  testicular  sac,  in  which  are  shown— let,  the  nock 
situated  above  the  letter  A,  and  concealed  in  the  inguinal  canal ;  2d,  a  middle  portion 
extending  from  A  to  E ;  3d,  a  fundus,  B  C,  whore  tha  testicle  is.  D  D,  division  of  the 
scrotal  artery.  P  G,  inferior  inguinal  ring,  whoso  internal  commissure  is  rounded 
and  formed  of  white  fibres  crossing  each  other  and  attached  to  tho  prepubic  tendon. 
H  n,  fleshy  portion,  from  tho  email  obliaue,  and  forming  tho  antirior  and  internal  lip 
of  the  inguinal  ring.  K  K,  postero  internal  edge  of  the  inguinal  ring,  formed  princi- 
pally by  an  aponeurotic  portion  of  the  great  oblique.  L,  scrotal  artery.  M,  veins  of 
the  scrotum  and  of  the  penis.  N,  part  of  tho  penis  thrown  bacliward.  o  o  o,  tunica 
abdominalis.    P,  muscles  of  the  flat  of  th3  thigh,  short  adductor  of  the  thigh. 

The   in/fuinal  canal  is   an  infundibuliform  cavity,  flattened 
from  one  side  to  tlie  other.     It  is  situated  in  the  groin,   and 


396  OPERATIONS    ON    THE    DIGESTITE    APPAKATUS. 

through  it  pass  the  testicular  cord  and  the  testicular  blood  ves- 
sels, in  the  male,  and  the  blood  vessels  of  the  mamm?e  in  the 
female,  as  they  emerge  from  the  abdominal  canity.  Situated  on 
one  side  of  the  preiDubic  region,  it  observes  an  oblique  direction, 
downward,  backward,  and  from  without  inward,  being  formed 
posteriorly  by  the  crural  arch,  and  anteriorly  by  the  fleshy  portion 
of  the  small  oblique  muscle  of  the  abdomen.  Inferiorly  it  has 
an  opening  called  the  inferior  inguinal  ring,  which  is  made 
through  the  aponeurosis  of  the  great  obhque,  oval  in  shape,  and 
jDossessing  two  %:>s,  edges  or  pillars,  united  together  by  two 
commissures.  The  lii^s,  divided  into  anterior  and  posterior,  are 
formed  by  the  fibres  of  the  aponeurosis  of  the  great  oblique 
muscle  of  the  abdomen,  and  a  few  of  the  muscular  fibres  of  the 
small  oblique,  reinforced  by  some  bands  of  the  tunica  abdominalis. 
The  commissures,  divided  into  external  and  internal,  result  from 
the  union  of  the  extremities  of  the  two  pillars.  The  superior 
opening  of  the  inguinal  canal  is  known  also  as  the  peritoneal 
or  stiperior  inguiyial  ring,  and  is  situated  in  front  of  and  dii-ectly 
opposite  the  crural  ring.  It  represents  a  single  sht,  subject  to 
dilatation,  placed  also  between  the  crural  arch  and  the  small 
oblique  of  the  abdomen,  and  allowing  on  its  inner  border  the  pas- 
sage of  the  anterior  pudic  or  posterior  abdominal  artery,  it  sur- 
roimds  the  neck,  and  forms  the  entrance  of  the  vaginal  sheath.  It 
is  open  in  horses,  and  often  in  bo\dnes  also,  and  it  allows  a  du-ect 
commimication  between  the  cavity  of  the  vaginal  sac  and  that  of 
the  peritoneum — undoubtedly  a  predisj^osing  condition  to  hernias, 
not  to  be  overlooked.  The  testicular  sac  ofi^ers  to  our  attention, 
from  the  point  of  view  from  which  we  now  consider  it,  an 
entrance,  or  true  infundibulum,  overlapping  the  internal  opening 
of  the  inguinal  ring  or  canal ;  a  tieek  situated  just  below  that  ring, 
a  continuation  of  the  infundibulum  or  entrance,  and  which  at  a 
short  distance  from  its  origin  ofi'ers  a  well  marked  contraction  in 
its  diameter — this  being  the  point  where  strangulation  takes 
place — a  middle  part,  containing  the  sj^ermatic  cord;  and  a 
bottom,  or  true  cul-de-sac,  where  the  testicles  and  the  ej)ididymis 
are  lodged. 

The  special  signification  of  the  terms  which  have  been  else- 
where and  already  employed  to  designate  and  classify  the  varie- 
ties of  form  and  manifestation  characterizing  different  varieties  of 
hernia  are  of  interest,  and  should  not  be  lost  sight  of.     They  are 


HERNIA.  397 

di\dded  principally  into  recent  or  acute,  and  old  or  chronic,  and 
we  find  them  considered  as  enter ocele,  epiplocele,  and  enter o- 
epiplocele,  according  to  their  contents.  The  name  of  vaginal 
hernia  has  been  used  to  denote  a  case  in  which  the  intestine  is 
directly  engaged  in  the  inguinal  canal;  and  hernia  of  the  ring,  or 
hernia  in  the  canal,  describes  that  in  which  the  viscera  have  en- 
tered but  a  short  distance  into  the  sheath.  Bubonocele  signifies 
that  the  intestine  has  entered  but  a  very  slight  distance  into  the 
inguinal  sheath,  in  opposition  to  the  oscheocele  or  scrotal  hernia, 
when  the  intestine  falls  quite  down  into  the  sac,  and  with  the 
testicles  themselves,  occupies  the  bottom  of  the  scrotum. 

Inguinal  hernias  are  generally  accidental,  but,  as  some  authors 
hold,  are  also  sometimes  congenital,  having  been  found  existing 
at  bii-th;  and  in  many  instances  they  become  permanent,  the  in- 
testines occupying  the  vaginal  sac  without  change,  as  a  fixity. 
Then,  again,  they  may  be  intermittent,  disappearing  more  or  less 
completely,  under  pecuhar  conditions,  only  to  reappear  under  the 
stress  of  new  influential  causes.  Of  course  the  classification  of  re- 
ducible and  irreducible,  always  holds.  The  classification  of  the 
hernia  of  castration,  which  takes  place  during  or  after  that  opera- 
tion, is  considered  by  some  to  be  properly  one  of  the  forms  of 
eventration. 

A  consideration  of  the  anatomical  disposition  of  the  vaginal 
canal,  and  especially  of  its  upper  ring,  which  prasents  an  opening 
communicating  with  the  peritoneal  cavity,  will  explain  the  reason 
why  inguinal  hernias  of  the  horse  are  more  common  in  the  stallion 
than  in  the  gelding.  It  is  rare  in  bovines,  but  Lafosse  has  seen 
it  in  sheep  and  in  rams  and  although  the  anatomical  disposition 
of  the  canal  in  the  dog  render  its  occurrence  difiicult,  Wolstein 
has  observed  it  in  that  aninial.  Cases  are  rare  in  females,  but 
Girard,  Jr.,  has  seen  it  in  mares,  Rychner  in  cows,  and  Hering, 
Hertwig  and  Goubaux  in  bitches. 

Recent  iNoirrNAL  Hernia. 
'\i\Tien  the  hernia  appears  suddenly,  in  a  subject  not  jyredis- 
posed  to  it,  the  first  symptoms  are  those  of  abdominal  pain,  ap- 
pearing suddenly  and  without  warning,  and  quite  inconsistent 
with  the  general  perfect  health  of  the  animal.  These  symptoms 
are  at  first  vague  in  their  significance,  and  definable  merely  as  ex- 
hibitions of  simple  pain  in  the  abdomen. 


398  OPERATIONS    ON    THE    DIGESTIVE    APPARATUS. 

If  iu  tile  stable,  tlie  animal  becomes  restless,  paws  with  bis 
fore  feet,  gazes  earnestly  toward  his  flanks,  and  flexes  his  legs, 
as  if  to  lie  down,  and  perhaj)S  accomplishes  that  movement,  but 
only  to  resume  the  standing  position.  The  skin  is  moist,  the  per- 
spiration apiDearing  on  the  face,  around  the  ears,  behind  the 
shoulders  and  in  the  groins.  If  he  is  in  harness,  his  action  is 
changed,  he  shortens  his  steps,  stops  pulling,  wants  to  stand  still, 
and  becomes  covered  with  abundant  perspiration  running  over 
him  and  di'ij)ping  from  his  bell}^  These  first  sjTnptoms  excite 
suspicion  as  to  the  real  cause  of  the  trouble,  but  they  soon  assume 
a  character  which  changes  the  suspicion  into  certainty.  They  rap- 
idly assvime  greater  severity,  increasing  in  the  ratio  of  the  suffer- 
ings of  the  animal,  which  then  has  no  more  rest  or  intermission, 
and  gives  evidence  of  the  most  intense  abdominal  j)ain.  He  paws 
and  stamps  upon  the  floor  more  and  more  violently,  sometimes 
kicking  his  abdomen;  gazes  anxiously  toward  his  flanks;  lies 
carefully  down  and  rolls  to  and  fro  on  his  back,  sometimes 
keeping  the  dorsal  jjosition  for  a  few  moments,  as  if  he  could 
only  thus  find  relief;  then  suddenly  rises  to  his  feet  and  rejDcats 
the  movements,  which  give  evidence  of  the  torture  he  suffers,  but 
more  forcibly  and  rapidly  than  before.  The  expression  of  his 
face  soon  becomes  characteristic.  The  lips  are  contracted,  the 
nostrils  are  retracted  and  dilated,  and  the  widely  opened  eyes  ap- 
pear unnaturally  large  and  prominent,  rendering  then*  agonized 
expression  more  and  more  striking.  The  respiration  becomes  ac- 
celerated and  the  pulse  more  rapid;  the  perspiration  streams 
more  copiously  from  his  body  and  the  poor  animal  groans  under 
the  weight  of  his  trouble. 

After  a  lapse  of  some  hours,  the  time  arrives  for  the  occurrence 
of  strangulation,  which  may  be  pronounced  the  crisis  or  fatal 
event  of  inguinal  hernia.  It  is  characterized  by  a  peculiar  mo- 
tion of  the  head,  which  is  thrown  up  and  down  repeatedly  (and 
which  the  French  have  designated  by  the  word  "  encense.'")  This 
motion,  which  is  sometimes  habitual  with  horses  while  in  harness, 
has  a  pecuhar  meaning  when  it  becomes  the  expression  of  the 
colic  of  hernia.  It  is  then  performed  slowly,  the  head  being  ele- 
vated gradually  and  extended  upon  the  neck,  to  be  suddenly 
dropped  again  as  if  from  weakness,  to  be  again  raised  and 
dropped  during  the  few  and  brief  intervals  of  remission  of  the 
pains,  while  the  animal  possesses  the  abihty  to  keep  on  his  feet. 


HEENIA.  399 

In  fact,  when  the  hernia  is  completed,  the  colics  are  so  violent  that 
the  animal  no  longer  lies  down,  but  literally  throws  himself  with 
violence  upon  the  ground,  having  become  forgetful  of  the  natui-al 
instinct  of  conservation,  and  now  rendered  indifferent  to  all  other 
pain  by  the  overpowering  force  of  the  hernial  torture.  With  his 
body  covered  with  bruises,  and  bleeding  from  numerous  superfi- 
cial wounds,  he  now  becomes  a  p)itiable  object.  There  are  animals 
of  particularly  sensitive  temperament  which  wUl  even,  like  those 
in  a  rabid  furor,  bite  themselves  on  their  flanks  and  forearms  in 
their  delirious  desperation. 

During  these  excessive  sufferings  there  seem  to  be  just  two 
positions  in  which  the  animal  can  experience  a  comparative  de- 
gree of  comfort.  They  are,  lying  on  his  back,  or  maintaining  the 
dog-sitting  posture,  on  his  haunches.  But  these  movements  of 
reprieve  are  of  but  short  duration,  and  the  pains  may  continue  to 
be  manifested  without  cessation,  by  tumultuous,  violent,  unequal 
struggles,  which  may  continue  twelve  or  fifteen  hours,  or  even 
more.  At  last,  toward  from  the  fifteenth  to  the  twentieth  hour, 
all  the  signs  of  pain  subside,  and  a  great  calm  succeeds  to  the 
previous  violent  agitation.  This,  however,  is  far  from  being  a 
good  sign,  or  an  indication  of  the  termination  of  the  disease.  It 
is,  on  the  contrary,  a  sure  token  that  a  fatal  termination  is  close 
at  hand,  and  if  the  patient  has  ceased  to  suffer,  it  is  because  the 
anesthesia  of  death  has  fallen  upon  the  organ  in  which  his  pains 
originated.  The  parts  which  were  so  recently  altogether  too  much 
alive,  have  died.  Gangrene  has  attacked  the  imprisoned  intestine, 
and  with  its  apjiearance,  loss  of  feeling  has  also  come — and  death 
— for  death  is  the  loss  of  feeling.  The  animal  is  now  in  a  con- 
dition of  extreme  prostration.  The  temperature  is  diminished ; 
the  perspiration  is  cold,  the  pulse  is  imperceptible,  his  face  is 
without  expression,  the  poor  brute  can  scarcely  maintain  a  stand- 
ing posture  or  move  his  legs  when  urged  to  stir,  and  when  the 
last  remnant  of  his  strength  is  exhausted,  after  a  few  hours,  he 
drops  upon  the  earth  and  dies  without  a  struggle.  Death  rarely 
delays  beyond  twenty-fom-  hours  following  the  strangulation. 
This  is  the  extreme  limit,  and  in  the  greatest  number  of  cases  it 
takes  place  within  a  shorter  period. 

These  manifestations  (the  description  of  which  we  borrow  from 
H.  Bouley),  constitute  the  series  of  general  symptoms  of  hernia, 
but,  at  the  same  time,  they  do  not  belong  exclusively  to  that  kind 


400  OPERATIONS  ON  THE  DIGESTIVE  APPARATUS. 

of  injury.  They  are  those  of  any  violent  abdominal  pain  spring- 
ing from  any  cause,  and  may  be  met  with  in  invaginations,  volvulus, 
intestinal  obstruction,  etc.  But  if  not  possessing  any  positive  and 
intrinsic  significance  in  themselves,  they  assume  great  value  in  the 
diagnosis,  when  added  to  the  series  of  local,  ox  pathognomic  symp- 
toms which  have  their  origin  and  limit  in  the  inguinal  region. 

Two  methods  are  available  for  the  location  of  the  seat  of 
the  lesion,  one  being  the  external  exploration  of  the  inguino- 
scrotal  parts,  the  other  consisting  in  the  internal  rectal  examin- 
ation of  the  pubic  region.  In  a  horse,  and  especially  a  stallion, 
suffering  from  cohcs,  the  indication  to  a  general  and  immediate 
examination  of  the  inguinal  region,  for  abnormal  appearances,  is 
always  present,  and  it  will  not  be  safe  to  be  too  easily  satisfied 
with  visual  examination  exclusively,  to  become  certain  that  no 
part  of  the  intestines  is  engaged  in  the  vaginal  sac.  The  eye 
may  be  deceived;  it  is  the  touch  alone  which  will  prevent  all 
possibility  of  error.  The  sensation  imparted  to  the  touch  at  the 
beginning  of  a  recent  inguinal  hernia  is  that  of  a  thickened  testi- 
cular cord  which  has  lost  its  usual  supj)leness,  and  whose  con- 
stituents can  no  longer  be  determined  under  the  pressure  of  the 
fingers.  Thus  thickened,  the  cord  gives  a  sensation  of  resistency, 
increasing  as  the  exploration  is  carried  further  up  in  the  groin, 
while  toward  the  bottom  of  the  sac,  the  scrotal  mass  feels  fuller 
than  usual,  the  testicle  becoming  less  movable,  giving  the  sensa- 
tion of  a  sHghtly  pufiy  tumor.  After  several  hours  duration  of  the 
disease,  the  characters  become  better  marked,  in  consequence  of 
the  increase  in  the  size  of  the  intestine,  and  the  amount  of  exu- 
dation, and  there  is  also  a  formation  of  gases  above  the  neck  of 
the  sac,  which  also  contributes  to  its  increase  in  size. 

The  hernial  tumor  has  thus  become  changed  from  its  original 
appearance,  by  its  enlarged  size,  and  is  easily  detected  by  the  great 
general  tension  caused  by  the  presence  of  the  accumulating  gases ; 
the  cord  is  found  to  be  tumefied  in  its  whole  length,  while  its 
renitentcy  increases  as  it  extends  upward  into  the  canal.  Du-ect 
pressure  with  the  fingers  upon  the  tumor  does  not  seem  to  cause 
great  pain,  probably  because  this  local  sensation  is  dulled  by  the 
extension  of  the  excessive  j)ains  which  radiate  from  the  hernia 
throughout  the  entire  abdominal  system.  The  external  characters 
of  the  inguinal  tumor  become  more  noticeable  when  both  sides  of 
the  testicular  regions  are  compared,  the  difference  between  the 


HERNIA.  401 

healthy  and  the  diseased  regions  being  then  easily  ascertained. 
Continued  spasmodic  movements  of  the  healthy  testicles  have 
been  observed. 

In  the  rectal  examination  of  the  horse,  the  hand  may  be  easily 
carried  beyond  the  anterior  border  of  the  pubis,  and  the  condition 
of  the  superior  ojoening  of  the  inguinal  canal,  and  the  state  of  the 
organs  engaged  in  it  thus  ascertained. 

In  the  normal  condition,  the  anterior  pillar  of  the  superior 
opening  of  the  canal  is  easy  of  identification.  It  is  in  front  and 
on  each  side  of  the  pubic  region,  and  by  reason  of  the  extensi- 
bihty  of  its  muscular  structure,  reqmres  no  greater  force  for  its 
separation  from  the  posterior  pillar  than  the  introduction  of  two 
fingers  into  the  ring.  When  the  intestine  is  in  the  vaginal  canal, 
after  having  passed  through  the  superior  openiiig,  it  can  be  felt 
with  the  hand  through  the  walls  of  the  rectum,  its  situation  being 
generally  on  the  inner  side;  and  being  thus  recognized,  it  can  be 
raised,  pulled  upon,  and  sometimes  even  extracted  from  the  open- 
ing through  which  it  had  passed.  But  to  be  able  to  judge  accu- 
rately the  nature  of  the  object  which  has  been  felt,  requires  in 
the  surgeon  an  amount  of  experience  in  the  taxis  not  always  pos- 
sessed, while  its  absence  may  at  times  betray  the  explorer  into 
serious  error.  Moreover,  the  sensations  transmitted  through  the 
rectum  cannot  ia  every  case  be  truly  interpreted,  and  it  sometimes 
becomes  necessary  to  combine  the  two  modes  of  examination  em- 
ployed simultaneously — the  rectal  investigation  and  the  external, 
manual,  testicular  exj)loration. 

Thus,  when  with  one  hand  in  the  rectum,  pressing  on  the  in- 
ternal ring,  and  the  other  pushed  well  into  the  depths  of  the  in- 
guinal region,  both  are  brought  in  contact,  and  it  is  discovered  by 
the  actual  touch  that  the  inguinal  canal  is  clear,  the  hypothesis 
of  strangulated  hernia  is  at  once  negatived. 

On  the  other  hand,  if  there  is  hernia,  and  the  imprisoned  intes- 
tine is  encountered,  the  fingers  of  the  two  hands  cannot  jjossibly 
come  in  contact,  and  the  next  question  will  be  one  of  indication, 
if  not  of  prognosis. 

As  a  rule,  the  prognosis  of  recent  inguinal  hernia  is  always  seri- 
ous. If  develoj^ed  without  organic  predisjDOsition  it  is  necessarily 
a  serious  lesion  by  reason  of  its  tendency  to  spontaneous  stra-ngu- 
lation,  which  when  unreheved  means  death  by  torture,  unless  the 
fatal  event  should  be  humanely  anticipated  and  prevented  by  the 


402  OPEEATIONS    ON    THE    DIGESTIVE    APPABATUS. 

fiat  of  a  compassionate  master.  But  a  fatal  prognosis  need  not 
be  unnecessarily  volunteered.  Timely  and  vigorous  measures,  es- 
pecially emphasizing  the  "  timely,"  may  still  prevent  the  strangu- 
lation and  defer  the  sentence  of  mortahty,  and  the  sooner,  there- 
fore, the  means  of  rehef  are  applied,  the  more  certain  will  be  their 
effect.  Every  minute's  delay  increases  the  force  of  the  disease  and 
lessens  the  chances  of  success.  It  is  rarely  the  case  that  the  lapse 
of  fifteen  hours  leaves  any  room  for  confidence,  though  it  is  not 
yet  time  to  abandon  hope.  Within  that  period  there  are  many 
chances  for  saving  the  patient,  but  after  the  earlier  periods  of  the 
attack  a  single  hoirr's  neglect  may  be  fatal — that  horn-  may  prove 
to  be  the  turning-point  of  the  conflict. 

The  treatment  of  recent  inguinal  hernia  assumes  two  forms, 
consisting  of  the  taxis,  and  the  operation  of  herniotomy,  or  the  en- 
largement of  the  neck  of  the  vaginal  sheath  with  a  cutting  instru- 
ment. The  first  mode  is  indicated  at  once,  or  as  soon  as  the  her- 
nia is  recognized.  The  reduction  must  be  accompHshed  in  the 
shortest  time  possible,  the  danger  of  strangulation  becoming  more 
imminent  and  threatening  with  the  lapse  of  every  moment.  The 
taxis  may  give  immediate  relief,  and  may  be  materially  assisted  by 
douches  of  cold  water. 

In  this  case  the  taxis  consists  in  the  manipulation  of  the  part 
with  the  hands,  by  pressure  and  otherwise,  for  the  purpose  of  re- 
placing the  protruding  intestine  in  its  proper  cavity ;  technically, 
the  reduction,  of  the  hernia.  This  manipulation  is  appUed  either 
by  simple  pressure  over  the  external  surface  of  the  diseased  part, 
or,  if  practicable  and  necessary,  by  supplementing  it  with  a  proper 
traction  appUed  upon  the  intestine  from  within  through  the  rectal 
walls.  This  manipulation  may  be  applied  by  two  processes,  first 
the  subcutaneous,  medial  or  indirect^  and  second,  the  direct  taxis. 

1st.  The  Indirect  Taxis. — In  the  first  or  indii'ect  method,  the 
animal  is  placed  in  a  standing  position,  with  the  hind  legs  secured. 
Then  the  hand  and  arm  of  the  oj)erator,  well  oiled,  are  introduced 
into  the  rectum,  using  the  right,  if  he  is  to  operate  on  the  left  side, 
and  vice  versa.  When  in  the  rectal  cavity,  the  hand  is  carried  to 
the  anterior  border  of  the  pubis,  while  with  the  other,  jDassed  in 
front  of  the  patella,  pressure  is  appHed  upon  the  scrotal  sac,  and 
the  intestine  pushed  toward  the  superior  opening.  The  hand  in 
the  rectum  then  grasps  the  loops  of  the  hernia,  tkrough  the  rectal 
walls,  and  at  the  same  time  pulls  them  upward.     Thi'ough  these 


HEENIA.  403 

manipulations  the  surgeon  may  succeed  in  removing  the  difficulty, 
if  by  that  time  the  testicular  sheath  continues  to  be  free  from  con- 
gestion. But  if  this  ah'eady  exists,  and  the  coUcs  are  increasing 
in  severity,  the  taxis  in  the  standing  position  becomes  impossible 
and  it  will  be  necessary  to  throw  the  animal.  This  done,  he  must 
be  placed  in  the  dorsal  position,  with  his  hind  legs  kept  apart  and 
his  haunches  raised  as  much  as  possible  by  bunches  of  straw. 

In  this  position,  the  operator  must  j)roceed  to  practice  what 
must  be  described  as  an  exceedingly  delicate  massage  or  taxis 
ujDon  the  scrotal  sac,  both  hands  being  used,  in  such  a  manner  as 
to  crowd  or  press  the  intestinal  mass  toward  the  superior  opening 
of  the  canal.  The  design  of  this  is  to  stimulate  the  cii'culation 
thi'ough  the  capillaries,  and  also  to  free  the  cavity  of  the  intestine 
from  the  semi-fluid  and  gaseous  contents  which  may  be  present, 
by  this  means  diminishing  its  volume  and  facilitating  its  reduction. 

That  this  must  be  done  with  the  utmost  caution  and  patience, 
needs  hardly  to  be  urged.  And  it  should  be  persevered  in  for  at 
least  a  period  of  thirty  seconds  before  advancing  to  the  other 
stei3,  which  consists  in  gradually  pushing  the  intestine  toward 
the  opening.  If  the  protruding  loop  is  not  too  long,  and  the 
massage  has  succeeded  in  its  design,  and  the  bulk  of  the  tumor 
has  been  sufficiently  diminished,  and,  above  aU,  if  the  hernia  has 
had  but  a  short  existence,  it  may  be  within  the  probabilities  that 
this  external  taxis  alone  will  be  sufficient  to  reduce  it.  But  such  a 
result  cannot  be  counted  on  with  any  degree  of  certainty,  and  it 
is  then  the  simple  dictate  of  wisdom  to  make  assurance  sure,  if 
possible,  by  having  recourse  to  double  taxis,  and  attacking  the 
danger  at  both  its  internal  and  external  accessible  points. 

For  a  single  operator  to  undertake  the  performance  of  both 
branches  of  this  compound  manipulation  can  hardly  be  advised. 
Few  men  possess  the  necessary  powers  of  endurance,  and  an  acci- 
dent might  easily  compi'omise  the  very  life  of  both  surgeon  and 
patient.  At  the  least,  it  involves  quite  an  unnecessary  amount  of 
effort  and  fatigue.  All  the  reasons  are  in  favor  of  a  division  of 
the  work,  by  which  a  competent  assistant  will  be  put  in  charge 
of  the  rectal  taxis  portion  of  the  labor,  while  the  practitioner  in 
chief  will  direct  and  execute  all  the  other  steps  of  the  treatment. 

The  successful  result  of  the  operation  will  be  known  at  once 
by  the  diminution  of  the  tumor,  the  disappearance  of  its  puffy 
and  tense  condition,  by  the  sudden  sensation  of  yielding,  felt  by 


404  OPERATIONS    ON    THE    DIGESTIVE    APPARATUS. 

the  hand  working  in  the  rectum,  and  also  by  the  facility  with 
which  the  fingers  of  that  hand  can  be  introduced  into  the  now 
liberated  superior  ring. 

Anesthetics  have  been  recommended  as  powerful  adjuncts  in 
the  apphcation  of  the  taxis,  in  this  class  of  cases.  Bouley 
recommended  their  use,  and  Bagge,  a  Russian  veterinarian, 
agrees  with  Bouley,  in  advising  their  administration.  His  pro- 
ceeding is  thus  described:  The  rectum  being  emptied,  a  solution 
of  two  to  four  grammes  of  chloral  and  sixty  or  seventy  centi- 
grammes of  acetate  of  morphia  are  thrown  into  it,  while  at  the 
same  time  compresses  of  chloroform  are  laid  on  the  diseased  side 
of  the  inguinal  region.  In  the  course  oi  ten  minutes  there  is 
such  a  relaxation  of  all  the  tissues  that  the  reduction  by  rectal 
taxis  is  quite  easy.  The  spermatic  cords  are  then  surrounded  by 
rolls  of  bandages  moderately  tight,  in  order  to  prevent  the  return 
of  the  hernia.  These  bandages  are  left  on  for  eight  or  ten  hours. 
The  danger  of  strangulation  upon  the  testicular  cords  is  an  im- 
portant objection  to  the  adoption  of  this  process.  Severe  appli- 
cations of  douches  of  cold  water  applied  for  one  or  two  hours 
previous  to  the  taxis  have  been  successfully  employed  by  Steff 
and  Lacassin. 

A  process  known  as  that  of  Patey,  from  its  discoverer,  con- 
sists in  the  injection  of  oil  of  belladonna  into  the  hernial  sac,  the 
action  of  the  oil,  it  is  claimed,  producing  the  dilation  of  the 
pseudo-sphincter,  which  prevents  the  reduction.  It  causes  a  cer- 
tain flaccidity  of  the  parts,  renders  the  taxis  much  easier,  and  con  ■ 
siderably  facilitates  the  reduction. 

2d.  The  Direct  Taxis. — This  procedure  is  of  too  dangerous  a 
character  to  maintain  a  place  in  the  domain  of  veterinary  surgery, 
except  under  very  exceptional  conditions.  It  consists  in  apjDly- 
ing  the  manipulations  of  the  taxis  directly  upon  the  intestine, 
previously  exposed  by  the  dissection  of  the  testicular  enveloj)es. 
These  manipulations,  which  are  dangerous  when  the  intestine  is 
distended  by  gases  or  fluids,  may,  however,  be  rendered  easier  by 
relieving  the  intestinal  loop,  through  the  use  of  a  fine  needle- 
trocar  or  aspirator,  of  the  cause  of  its  abnormal  dilatation. 

The  method  of  Renault,  mentioned  by  Zundel,  is  also  a  form 
of  direct  taxis  which,  though  it  may  be  employed  in  cattle,  involves 
a  subsequent  fatal  peritonitis  in  the  horse.  The  operation  con- 
sists in  the  opening  of  the  flank  and  the  performance  of  the  re- 


HERXIA.  405 

duction  by  direct  traction  with  the  hand  thus  introduced  into  the 
abdomen. 

The  operation  of  herniotomy  is  that  which  consists  in  the 
section  of  the  neck  of  the  vaginal  ca%"ity.  It  is  the  proper  opera- 
tion iov  strangulated  he7'7iia.  Bouley  has  said:  "This  operation 
is  not,  as  one  may  be  inclined  to  think,  a  last  resource,  which  is 
not  to  be  used  except  after  the  taxis,  under  its  various  forms,  has 
been  appUed  and  failed.  Far  from  it.  We  believe,  on  the  con- 
trary, that  in  the  horse,  the  taxis  is  a  means  of  treatment  which 
is  truly  indicated  only  in  the  first  five  or  six  hours  of  the  descent 
of  the  intestine ;  that  even,  in  this  first  period  of  time,  one  must 
not  use  it  too  much  nor  too  long,  from  fear  of  the  compHcations 
which  might  arise  through  the  rectal  manipulations,  and  that 
after  this  limit  of  a  few  hours  has  elapsed,  it  is  better  to  have  re- 
coiu'se  immediately  to  the  operation,  without  trusting  to  vain 
hopes  from  the  use  of  the  taxis."  The  operation  is  comparative- 
ly a  simple  one,  the  dangers  which  were  formerly  apprehended 
having  been  greatly  reduced  by  a  better  knowledge  of  the  seat  of 
the  strangulation,  and  of  the  parts  to  be  di\ided,  and  the  ratio  of 
mortahty  is  now  so  small — forty-two  recoveries  out  of  fifty-two 
operations — that  hesitation  is  no  longer  justifiable. 

The  instruments  required  for  this  operation  are  straight  and 
cui'ved  bistouries,  scissors,  an  ordinary  director,  a  herniotome 
(Figs.  384a,  385),  or  blunt,  straight  bistoury,  and  a  pair  of  ciu'ved 
clamps  vdth  strong  cords  to  secure  their  branches.  The  hernio- 
tome is  a  hi stoury -cache ^  which,  however,  since  the  use  of  general 
anesthesia,  has  been  replaced  by  the  blunt,  straight  bistoury,  en- 
ables the  operator  to  di\T.de  the  neck  of  the  vaginal  sheat'h  in  the 
right  place  with  more  certainty  than  heretofore,  and  to  regulate 
more  accurately  the  dimensions  necessary  to  relieve  the  strangu- 
lation. The  director  which  is  best  adapted  for  use  in  herniotomy 
is  one  which  has  a  flat,  lanceolated,  grooved  surface  at  one  end, 
and  which,  while  it  guides  the  blade  of  the  bistoury,  contributes 
likewise  to  the  protection  of  the  intestine  against  the  possibility 
of  injury  by  the  sharp  edges  of  the  bistoury. 

The  patient  to  be  operated  on  is  laid  upon  a  soft  bed,  anes- 
thised  as  completely  as  possible,  and  placed  upon  his  back.  The 
hind  leg  corresponding  to  the  side  where  the  hernia  is  located  is 
freed  from  the  hobble,  secured  with  a  roj^e,  and  carried  outward 
in  abduction,  with  the  rope  made  fast  to  a  fixed  point  near  by — 


406 


OPERATIOXS    ON    THE    DIGESTIVE    APPARATUS. 


Fig.  385. 
Herniotomes  of  Colin. 


as  a  ring  in  the  wall,  a  post,  a  tree,  or 
other  immovable  object.  If  the  opera- 
tion is  to  be  performed  at  night,  which 
is  too  often  necessarily  the  case,  the 
presence  of  additional  assistants  will 
probably  be  required,  in  order  to  insure 
an  abundant  amount  and  proper  man- 
agement of  Hght,  which  is  indispensable 
in  so  delicate  a  dissection. 

In  operating,  the  surgeon  kneels  be- 
hind the  patient  and  ^ith  a  curved  bis- 
toury begins  by  making  a  long  incision 
upon  the  tumor,  parallel  with  the  long 
axis  of  the  testicle. 

This  incision  is  similar  to  that  which 
is  made  in  castration  with  covered  testi- 
cles, and  must  involve  only 
'  the  scrotum,  the  dartos, 
and  the  first  layers  of  the 
lamellated  cellular  tissue 
which  unite  this  last  to  the 
tunica  erythroidea.  The 
remaining  portion  of  this 
lamellae  is  then  carefully 
incised,  iintil  the  fibrous 
coat  is  exposed,  and  the 
tumor  is  entirely  enuclea- 
ted from  its  envelojDe  of 
cellular  tissue.  This  done, 
the  fibres  of  the  tunica 
erythi-oidea  are  scraped 
apart  with  the  point  of  the 
straight  bistouiy,  until  the 
vaginal  sac  has  been  open- 
ed, which  the  operator  dis- 
covers by  the  appearance 
of  a  stream  of  liquid  pass- 
ing through.  The  canula- 
ted  director  is  then  intro- 
duced into  the  opening  and 


HERNIA.  407 

guides  the  bistoury,  with  wliich  the  hernial  sac  is  now  freely 
opened,  in  front  and  behind.  This  free  cutting  allows  the  escape 
of  all  the  serous  or  sero-sanguineous  fluid  contained  in  the  sac, 
varying  in  quantity  according  to  the  duration  of  the  hernia. 

The  contents  of  the  hernial  sac  are  now  exposed.  They  consist 
of  the  testicle,  pushed  outward,  against  the  commissure  of  the 
ring ;  the  looj)  of  the  intestine,  placed  on  the  inner  side  of  the 
spermatic  cord,  rarely  extending  as  far  down  as  the  testicle,  but 
usually  reaching  to  the  level  of  epididymis,  and  again,  not  un- 
commonly remaining  in  the  condition  of  a  bubonoale.  But  what- 
ever may  be  the  dimensions  of  the  protruding  loop,  the  intestine 
is  always  easily  recognized  by  the  roundness  of  its  form,  the  smooth- 
ness of  its  surface  and  its  color,  which  may  range  from  various 
shades  of  red  to  bluish  black.  It  is  also  recognized  by  the  changes 
which  have  taken  place  in  its  consistency,  resulting  from  the  bloody 
and  serous  infiltration  which  has  taken  place  in  its  structure.  The 
intestine  should  now  be  carefully  wiped  off  with  a  soft,  fine  sponge, 
or  washed  with  lukewarm  water,  in  order  to  free  it  from  any  de- 
posits or  adhesions  of  serous  or  bloody  matter  that  may  be  present. 

The  opening  of  the  hernial  sac  should  be  immediately  followed 
by  the  exploration  of  the  neck  with  the  index  finger,  with  a  view 
to  the  determination  of  the  exact  point  where  the  strangulation 
exists,  and  to  judge  of  its  degree  of  tightness.  This  will  not  be 
found  upon  the  superior  opening  of  the  inguinal  canal,  as  thought 
by  Gu-ard,  D'Ai'boval,  Hertwig,  Hering,  Lafosse,  Rey,  Yerrier  and 
others,  but  shovild  be  looked  for  two  or  three  centimetres  below  that 
opening,  as  demonstrated  by  Bouley ;  that  is,  where  the  neck  of 
the  vaginal  sac  is  situated.  This  point  made  out,  if  the  hernia  is 
very  recent,  and  the  intestine  has  not  yet  become  the  seat  of  thick- 
ening, a  few  tactical  manipuMions  can  be  apphed,  the  internal 
face  of  the  vaginal  sac  having  first  been  lubricated  with  sweet  oil, 
or  some  mucilaginous  substance,  or  even  oil  of  belladonna ;  and 
even  cool  irrigation  has  been  of  service.  In  the  performance  of 
this  taxis  the  first  step  is  committed  to  the  assistant,  who  stretches 
both  borders  of  the  sheath  in  order  to  separate  them  in  the  form 
of  a  funnel,  the  testicle  being  drawn  outward,  in  order  to  stretch 
the  cord  also.  The  operator  then  applies  both  hands  upon  the  loop 
of  the  intestine,  and  with  moderate  and  gradual  pressure  endeavors 
to  push  it  through  the  neck  of  the  vaginal  sac.  Eectal  taxis  applied 
at  the  same  moment  may  also  be  of  great  assistance.     But  these 


408 


OPERATIONS    ON    THE    DIGESTIVE    APPARATUS. 


efforts  must  not  be  persevered  in  too  long.  If  not  successful  al- 
most immediately,  it  is  better  to  have  recourse  at  once  to  the  in- 
cision of  the  neck  of  the  sac  than  to  expose  the  intestine  to  the 
subsequent  effect  of  pressures  or  tractions  of  which  the  termina- 
tion may  be  a  fatal  gangrene.  The  following  steps  are  recom- 
mended by  Bouley  in  making  this  iucision.  Says  this  author :  "One 
assistant  takes  hold,  with  both  hands,  of  the  edges  of  the  incision 
made  through  the  vaginal  sac,  stretching  them  into  a  funnel  shape ; 
another  draws  the  testicle  outward  and  backward,  to  stretch  the 
cord.  Then  the  operator  having  explored  with  his  finger  the  con- 
dition of  the  neck,  introduces  the  blunt  bistoury  or  the  herniotome 
(Fig.  386)  as  far  as  the  neck  of  the  sac,  taking  for  his  guide  the 
index  finger  of  his  right  hand  (Fig.  388),  introduced 
into  the  neck  or  canulated  director,  and  holding  the 
instrument  in  such  a  manner  that  its 
back  rests  against  the  pulj)  of  the  fin- 
ger which  supports  it,  and  its  sharj) 
edge  turned  outward,  corresponds  to 
the  stiffened  band  of  the  neck,  to- 
wards the  internal  face  of  the  thigh. 
This  band  will  thus  become  stretched 
over  the  knife  in  such  a  manner  that 
it  divides  itself  upon  the  sharp  edge 
of  the  instrument,  with  the  aid  per- 
haps of  the  slightest  pressure  made 
by  the  finger  which  supports  it.  The 
important  point  is  to  make  a  very  hm- 
ited  incision,  dividing  only  the  thick- 
ness of  the  vaginal  sac  and  its  fibrous 
covering,  and  avoiding  the  wounding 
of  the  cremaster,  that  being  one  of  the 
conditions  of  the  closing  of  the  sheath. 
The  division  once  made,  the  degree  of 
dilatation  of  the  neck  is  readily  made 
out,  and  if  the  finger  can  be  easily  in- 
troduced into  it,  the  reduction  of  the 
hernia  becomes  then  an  easy  task. 

The  modus  o2)erancU  by  the  use  of 
the  herniotome  differs  but  little  from 
the  preceding.    Allien  this  instrument 


409 


Holding  the  Bistoury  upon  the  Grooved  Director. 


is  to  be  used,  a  careful  measurement  of  the  amount  of  opening  to 
be  allowed  to  the  blade  must  first  be  made.  Then,  guided  by  the 
side  of  the  index  finger,  and  with  its  blade  turned  outward,  the 
instrument  is  introduced  into  the  sac.  When  it  has  reached  the 
proper  point  where  the  division  is  to  be  made,  the  blade  is  brought 
out  by  pressing  upon  the  peculiarly-contrived  handle  of  the  instru- 
ment, and  the  division  of  the  band  of  the  neck  is  completed. 

After  the  division  at  the  point  of  strangulation,  the  taxis  is  to 
be  used,  both  externally  and  by  the  rectum,  carefully  taking  into 
consideration  the  condition  of  the  intestines  in  the  appHcatiou  of 
the  various  manipulations  required. 

Upon  reduction  of  the  hernia,  obliteration  of  the  sac  is  secured 
by  the  application  of  a  clamp,  curved  or  straight,  upon  its  parietal 
layers,  embracing  between  them  the  spermatic  cord.  In  short, 
the  final  steps  of  the  operation  will  be  precisely  those  by  which 
the  operation  of  castration  with  covered  testicles  is  completed. 

This  methed  of  closing  the  vaginal  sac  is  the  best,  the  simplest 
and  the  most  certain  in  its  results.  It  is  true  that  the  objection 
that  it  imphes  castration  is  a  weighty  one,  but  the  mutilation 
which  it  involves  is  a  condition  of  radical  recovery  which  cannot 
be  obtained  by  any  other  means.  The  attempts  which  are  made 
to  save  the  testicles,  which  are  justifiable  only  in  the  case  of  very 
valuable  animals  used  for  breeding  purposes,  are  nearly  always 
followed  by  fatal  results. 

Among  these  may  be  mentioned  the  process  by  which,  in- 
stead of  leaving  the  testicle  to  drop  under  the  efi"ect  of  the 
pressure  of  the  clamp,  it  is  left  inclosed  in  the  vaginal  sac,  whose 
divided  edges  are  brought  together  by  sutures. 

Schmidt  has  attempted  to  push  it  back  into  the  abdomen ;  but 
such  methods  have  been  followed  by  fatal  peritonitis.     Bouley  has 


410  OPERATIONS    ON    THE    DIGESTIVE    APPARATUS. 

also  advised  a  subcutaneous  herniotomy,  which  was  put  into  prac- 
tice afterwards  by  Siegen  &  Verrier,  in  which  the  careful  puncture 
of  the  sac  was  made  at  the  origin,  or,  preferably,  at  the  flabelli- 
form  insertion  of  the  cremaster.  After  enlarging  the  opening,  the 
index  finger  is  introduced  into  the  neck,  carrying  with  it  the  blunt 
bistoury  with  which  the  structure  is  divided,  and  the  reduction  is 
completed  by  the  taxis,  the  wound  being  closed  by  several  points 
of  suture.  The  use  of  antiseptics  in  our  day  obviates  a  large 
portion  of  the  danger  arising  from  the  comphcations  which  may 
follow  these  modes  of  operation. 

The  operation  for  strangulated  hernia  in  the  gelding  does  not 
differ  much  from  that  indicated  for  stallions,  except  in  the  man- 
ner of  closing  the  wounds,  the  clamp,  in  this  class  of  patients, 
being  apphed  upon  the  hernial  sac,  involving  the  skin,  as  is  done 
in  some  cases  of  treatment  for  umbilical  hernia. 

The  treatment  of  the  patient  subsequently  to  the  operation  is 
generally  a  simple  matter,  the  violent  coUcs,  -svith  other  manifesta- 
tions of  the  hernia,  having  suddenly  subsided,  and  the  patient 
being  comparatively  free  from  pain.  He  will  probably  give  evi- 
dence of  some  sHght  abdominal  uneasiness,  which  will  j)robably 
be  due  to  the  pressure  of  the  clamp  upon  the  testicular  cord,  but 
this  will  not  be  of  long  duration,  probably  requiring  no  other  at- 
tention than  a  moderate  walking  exercise. 

The  animal  is  then  turned  loose  in  a  box  stall  and  placed  upon 
a  diet  suited  to  his  case,  and  watched  for  future  developments. 
The  wound  requires  no  special  attention  but  cleanhness,  and 
towards  the  fifth  or  sixth  day,  when  the  suppuration  is  estab- 
lished, the  clamp  can  be  removed. 

It  is  about  this  time  that  comphcations  may  be  looked  for.  A 
fatal  peritonitis,  for  example,  may  apjpear  between  the  fifth  and 
tenth  day,  when  everything  has  seemed  to  be  progressing  favor- 
ably, and  bid  defiance  to  treatment,  especially  if  the  intestines 
were  already  in  a  gangrenous  condition  when  the  reduction  was 
made.  After  ten  days  there  need  be  no  more  fear  of  complica- 
tions, so  far  as  the  hernia  is  concerned,  but  it  is  not  yet  too  late 
for  those  of  castration,  which  may  still  occur.  The  duration  of 
convalescence  will  average  from  twenty  to  twenty-five  days,  after 
which  the  animal  can  resume  his  work.  A  return  of  the  hernia, 
recidlve,  is  a  rare  and  almost  impossible  event  when  the  reduction 
has  been  completed  by  castration. 


HERNIA.  411 

During  the  operation  certain  accidents  may  occur,  including 
eventr'ation,  an  extra  vaginal  hernia  and  injuries  to  the  intesti7ies. 
At  the  j)resent  time,  eventrations  are  rare,  by  reason  of  the  fact 
that  the  division  of  the  superior  ring  itself  is  no  longer  per- 
formed. Yet  they  may  occur  through  an  accidental  slip  of  the 
knife,  or  a  tearing  of  the  walls  of  the  vaginal  sheath  during  ma- 
nipulation for  the  reduction,  and  the  accident  is  usually  a  fatal  one. 

Of  extra  vaginal  hernia,  Bouley  says:  "While  making  the  in- 
cision of  the  neck,  sometimes  the  cremaster  muscle  is  divided  in 
the  direction  of  its  length ;  an  accident  possible,  especially  when 
one  uses  the  concealed  herniotome,  and  when  too  much  freedom 
is  allowed  to  its  blade.  It  is  then  possible  that  the  intestines  may 
become  engaged  through  this  incision,  and  appear  outside  of  the 
vaginal  sac,  above  the  inguinal  ring.  If  at  this  moment,  by  mis- 
aj)plied  taxis,  the  intestines  should  fail  to  re-enter  the  cavity  of 
the  sac,  eventration  may  take  place.  But  if,  on  the  contrary,  the 
intestine  is  first  carefully  returned  into  the  vaginal  cavity,  and 
then  into  the  peritoneum,  the  edges  of  the  peritoneal  opening  of 
the  canal  being  intact,  the  intestines  will  then  be  prevented  from 
making  another  exit." 

Wounds  of  the  intestines  may  take  place  either  through  a 
misdu-ection  of  the  bistoury  during  the  struggles  of  the  animal, 
or  possibly  from  the  nails  of  the  operator  or  his  assistants,  and 
the  fact  of  their  possibility  suggests  a  sufficient  hint  touching  the 
obvious  means  of  obviating  their  occurrence.  The  gravity  of 
these  injuries  will  be  measured  by  their  extent. 

Old  Inguinal  Hernia. 

Old,  or  chronic  inguinal  hernias,  are  those  of  which  the  charac- 
teristic condition  is  that  owing  to  the  state  of  dilatation  of  the  vag- 
inal sheath,  the  intestine  contained  in  it  is  enabled,  without  jeop- 
ardy to  the  life  of  the  patient,  to  continue  its  function  in  the  same 
manner  as  if  it  had  remained  in  the  open  cavity  of  the  abdomen. 
The  vaginal  sac  has  in  this  case  become  a  kind  of  large  diverticu- 
lum of  such  dimensions  as  to  allow,  without  interference,  the  work 
and  motion  of  the  intestinal  tract,  lodged  within  it,  to  go  on  in  a 
natural  way.  These  hernias  are  divided  into  continued,  or  perma- 
nent and  i?iterniittent — a  division  elsewhere  alluded  to — but  they 
may  also  be  distinguished  as  sinqyle  and  complicated. 


412  OPEKATIOKS    ON    THE    DIGESTIVE    APPAKATUS. 

Among  the  varieties  belonging  to  the  latter  category  may  be 
named:  the  laceration  of  the  superior  opening  of  the  testicular 
sheath;  the  collection  of  serosity  in  the  sac  (hydrocele);  the  sar- 
comatous transformation  of  the  testicle  where  the  hernia  exists 
(sarcocele);  the  adhesion  of  the  intestines  to  the  walls  of  the  sac 
(u-reducible  hernia) ;   with  obstruction  and  strangulation. 

Although  their  causes  belong  to  the  Hst  which  we  have  already 
considered,  there  is  still  a  sort  of  latent  difference  observable  in 
the  effects  to  which  they  severally  give  rise,  as  evidenced  by  the 
slowness  and  tardiness  of  their  matmity.  They  often  appear,  also, 
as  a  sort  of  relapse  or  reactionary  sequelae  (recicUve  of  the  French) 
of  acute  hernia  improperly  reduced,  or  as  a  consequence  of  the  ab- 
noi-maUy  dilated  condition  of  the  upper  ring,  while  this  constitutes 
a  predisposing  cause.  But  this  same  condition  of  dilatation  may 
be  congenital,  and  in  animals  wdth  a  jiredisiDOsing  conformation 
chronic  hernia  of  the  intermittent  kind  is  of  easy  occurrence. 
Whatever  may  be  their  mode  of  formation,  however,  they  are  gen- 
erally of  long  standing,  and  readily  diagnosticated  by  their  positive 
and  familiar  characters. 

Chi'onic  hernias  are  generally  of  larger  dimensions  than  the 
acute,  and  when  exclusively  vaginal,  filling  the  cavity  of  the  scro- 
tum and  forming  a  true  oscheocele.  If  the  laceration  of  the  supe- 
rior opening  of  the  canal  has  allowed  the  formation  of  a  sac  and  of 
an  adjunct  tumor,  in  front  and  outside  of  the  cord,  the  hernial  tu- 
mor will  then  consist  of  two  lobes,  the  smaller  situated  in  the  depth 
of  the  groin,  under  the  ventral  walls,  and  the  larger  occupying  the 
scrotal  sac. 

These  hernial  tumors  are  usually  formed  by  the  small  intestines 
and  the  floating  colon,  in  exceptional  cases,  by  the  pelvic  curva- 
ture of  the  colon  as  well.  They  vary  also  in  volume  as  well  as  in 
consistency,  from  an  obvious  cause ;  enlarging  after  meals,  to  con- 
tract again  when  the  abdomen  is  empty ;  and  again,  giving  various 
impressions  under  the  hand,  according  as  their  contents  are  gas- 
eous, liquid  or  soUd.  In  the  first  condition,  when  the  intestines 
are  empty  and  the  animal  is  at  rest,  the  tumor  is  soft,  supple,  elas- 
tic and  more  or  less  reducible,  but  when  the  animal  is  in  action  it 
increases  in  bulk,  and  becomes  more  tense  and  elastic,  and  less 
easy  of  reduction.  There  is  therefore  a  condition  of  intermittency 
in  their  character,  which  is  due  to  the  pecuHar  conditions  in  which 
the  animal  may  be  placed.     The  form  of  these  tumors  corresponds 


HERNIA.  413 

to  that  of  the  testicular  sac  in  which  they  are  contained,  the  in- 
guinal oscheocele  being  pyriform,  with  its  contracted  portion 
resting  in  the  groin. 

Vermicular  movements  of  the  intestines  and  borborygmus  are 
symptoms  easily  detected  in  large  hernias.  The  tumor  of  a 
chronic  hernia  is  painless,  or  nearly  so.  Rectal  examination 
furnishes  evident  indications  of  the  possibility,  and  of  the 
presence  of  the  hernia  by  the  degree  of  the  dilatation  of  the  ring 
and  the  size  of  the  organ  engaged  in  it.  In  such  a  case,  the  dila- 
tation may  be  so  great,  even  notwithstanding  the  presence  of  the 
intestines,  that  the  hands,  placed  respectively,  one  in  the  rectum 
and  the  other  in  the  inguinal  region,  can  be  brought  in  such  near 
proximity  as  to  touch  each  other.  All  these  symptoms,  taken  to- 
gether, or  even  isolated,  are  sufficiently  characteristic  to  establish 
a  positive  diagnosis  of  simple  chronic  hernia. 

The  serous  exudation  which  necessarily  exists  in  chronic 
hernia,  may,  when  it  is  excessive,  render  the  natm-e  of  a  hernial 
tumor  more  obscure,  and  give  it  the  appearance  of  a  case  of  true 
hydrocele,  the  serous  sac  in  these  cases  being  so  full  as  to  render 
it  impossible  to  discover,  either  by  sight  or  feeling,  the  presence, 
of  the  intestines  contained  in  it,  even  the  elastic  resistance  of  its 
walls  being  undetectable.  But  here  a  rectal  exploration  will  help 
to  solve  the  question ;  and,  again,  by  placing  the  animal  in  the 
dorsal  position,  the  gravitation  of  the  liquid  into  the  abdomen 
will  readily  reveal  the  truth  by  leaving  the  intestine  alone  in  the 
sac. 

Great  caution  is  necessary  in  these  doubtful  cases,  in  which 
a  misdirected  stroke  of  the  bistoury,  thoughtlessly  or  accidently 
made,  might  prove  certainly  fatal,  by  incising  the  intestinal 
knuckle,  which  it  really  is,  instead  of  simply  opening  the  mere 
serous  sac  which  it  was  supposed  to  be.  The  formation  of  a 
sarcocele  may  also  render  the  diagnosis  difficult.  In  these  cases 
the  testicle,  considerably  tumefied,  rough  on  its  surface,  and  hard 
and  painful,  is  felt  at  the  bottom  of  the  sac,  and  thus  conceals  the 
character  of  the  hernia.  Still,  with  sarcocele  hernia  coexistent, 
the  scrotal  tumor  acquires  an  appearance  and  proportions  differ- 
ent from  those  of  its  uncomplicated  state.  In  this  last  case,  the 
testicle  constitutes  the  principal  mass,  and  the  elongated  cord, 
stretched  by  the  weight  of  the  oi'gan,  can  be  easily  traced  with  the 
fingers  quite  up  into  the  groin.     If,  on  the  contrary,  both  hernia 


414  OPERATIONS    ON    THE    DIGESTIVE    APPARATUS. 

and  sarcocele  are  present,  the  testicle  is  bosselated  and  hyper- 
trophied,  and  the  cord  which  suj^ports  it  is  surrounded  by  the 
protruding  intestines,  which  form  on  the  outside  an  elongated 
mass,  of  a  consistency  either  puffy  or  perfectly  elastic,  according 
to  the  period  of  digestion.  Intelligent  rectal  exjDloration  will 
always  reveal  the  presence  of  the  intestine  through  the  ring. 

When  chronic  inguinal  hernia  becomes  comjolicated  with  acute 
inflammation  of  the  displaced  organ,  the  scrotal  tumor  becomes 
warm,  painful,  evenly  tense  and  remittent,  and  assumes  nearly  all 
the  characters  of  a  phlegmonous  tumor,  that  a  strong  tempta- 
tion is  offered  to  oj^en  it  with  the  bistouiy.  But,  if  this  is  con- 
templated, it  should  be  preceded  by  a  rectal  examination,  carefully 
made,  as  the  only  means  of  avoiding  a  possible  error  of  diagnosis 
whose  consequences  would  be  fatal.  If  the  inflammation  con- 
tinues to  be  localized,  the  intestine  contracts  adhesions  with  the 
walls  of  the  sac,  and  the  hernia  becomes  irreducible;  but  if,  on 
the  contrary,  the  phenomena  of  inflammation  extend  to  the  peri- 
toneum, an  acute  perit07iitis  is  estabUshed,  and  the  patient  suc- 
cumbs in  a  few  days. 

The  obstruction  or  engorgement,  which  is  a  possible  complica- 
tion of  chronic  inguinal  hernias,  consists  in  the  distension  of  the 
intestinal  loop  by  the  lodgment  of  alimentary  masses  of  varying 
bulk  Avhich  accumulate,  and  for  the  time  being,  occlude  the  intes- 
tinal tract.  This  complication  may  be  recognized  by  the  in- 
creased volume  of  the  tumor,  its  greater  weight,  and  the  sensa- 
tion of  a  softish  and  puffy  mass  contained  in  it.  It  is  often,  how- 
ever, but  a  temporary  trouble,  the  coHcs  which  attend  it  yielding 
easily  to  appropriate  treatment,  and  the  removal  of  faeces  from 
the  rectum  by  back-raking  being  often  sufficient  in  itself  to  afford 
relief.  But  in  exeeptional  cases,  treatment  fails  ;  the  obstruction 
becomes  persistent ;  the  faeces  accumulate  in  the  protruding  in- 
testines ;  the  tumor  is  increased  in  bulk,  and  at  length  a  period 
arrives  when  such  a  disproportion  between  the  volume  of  the  dis- 
tended intestine  and  the  capacity  of  the  opening  through  which 
it  has  passed  is  established,  that  all  the  conditions  necessary  for 
strangulation  are  fulfilled.  This  soon  takes  place  and  becomes 
evident  by  the  exhibition  of  symptoms  akin  to  those  pertaining 
to  its  analogue  of  the  recent  or  acute  variety.  There  is,  how- 
ever, a  difference  between  the  two  forms  in  respect  to  the  impor- 
tant matter  of  theu'  comparative  amenability  to  treatment,  inas- 


HERNIA.  415 

much  as  while  strangulation  in  the  acute  cases  is  only  relieved 
with  great  difficulty,  w^ithout  resorting  to  the  ojieration  of  herni- 
otomy, it  is  not  uncommon  in  those  of  a  chronic  character,  also 
strangulated,  to  succeed  by  a  careful  exercise  of  the  taxis,  in  dis- 
placing the  alimentary  mass  which  causes  the  obstruction,  and 
thus  forms  one  of  the  contributing  conditions  of  the  strangula- 
tion. It  is  only  in  case  of  failure  in  this  endeavor  that  herniot- 
omy becomes  admissible. 

A  chronic  inguinal  hernia  is  always  a  serious  ailment,  though 
not  necessai'ily  incompatible  with  the  life  and  health,  and  even 
partial  usefulness  of  the  horse.  It  must,  however,  constitute  a 
blemish  which  cannot  fail  largely  to  depreciate  his  commercial 
value,  since  it  must  always  be  liable  to  interfere  with  the  efficient 
performance  of  his  accustomed  labor,  besides  keeping  him  in  a 
state  of  greater  or  less  exposure  to  complications  and  tendencies 
which  are  a  constant  source  and  menace  of  danger  to  the  valetu- 
dinarian animal. 

Operations  for  the  relief  of  hernia  are  always  attended  with  a 
certain  gravity,  even  when  they  are  of  the  simplest  character  of 
which  they  are  capable,  and  if  compHcations  exist  the  danger 
must  necessarily  be  intensified  and  aggravated,  even  to  the  ex- 
tent of  jeopardizing  the  life  of  the  patient.  In  the  excellent 
work  of  Peuch  &  Toussaint,  speaking  of  the  applications  of  treat- 
ment, they  remark  :  "  In  animals  less  than  fifteen  months  of  age 
suifering  with  hernia,  the  expectant  method  is  the  proper  indica- 
tion, since  the  lesion  may  disaj)pear  as  the  animal  gets  older  and 
develops.  Inguinal  hernias  of  small  size  must  be  left  alone,  not 
interfering,  while  in  that  condition,  with  the  work  of  the  animal. 
The  operation  in  chronic  inguinal  hernias,  comphcated  with  lacer- 
ation of  the  supei'ior  oj^ening  of  the  inguinal  canal,  and  conse- 
quently with  ventral  hernia,  is  contra-indicated  by  the  imminent 
danger  of  the  occurrence  of  eventration  during  the  operation,  or 
when  the  clamp  is  removed.  "WTien,  however,  the  hernial  tumor 
has  assumed  such  enormous  dimensions,  that,  like  the  udder  of  a 
cow,  it  hangs  doT\ai  to  the  hocks,  there  is  no  more  contra-indica- 
tion,  the  animal  being  then  useless  -  and  yet  some  slight  chances 
of  success  still  remain.  Hernias  complicated  with  hydrocele,  sar- 
cocele  or  obstruction,  are  cases  calUng  for  operation,  and  when 
the  point  of  strangulation  has  been  reached,  the  indication  of 
immediate  and  urgent  interference  is  imperative." 


416 


OPEKATIONS    ON    THE    DIGESTIVE    APPARATUS. 


To  this  we  may  add,  with  Bouley,  that  the  operation  is  also 
indicated  when  the  hernia  is  exclusively  vaginal  and  of  stifficient 
proportion  to  interfere  with  the  locomotion  of  the  patient.  It  is 
also  indicated  as  a  means  of  preventing  its  further  development. 
The  operation  for  chronic  inguinal  hernia  identifies  itself  with 
that  of  castration  with  the  use  of  the  clamp,  and  by  the  process 
known  as  covered  testicles,  as  it  is  by  this  alone  that  the  accom- 
plishment of  the  ultimate  purpose  in  the  reduction  of  the  hernia 
and  release  of  the  strangulation  can  be  obtained.  The  instru- 
ments required  are  those  needed  in  castration.  The  clamp,  how- 
ever, requires  to  be  of  increased  length  and   dimensions,  and 


straight  and  Curved  Clamp. 


curved,  in  order  to  adapt  itself  to  the  parts.  A  broad  cloth,  such 
as  a  bed  sheet,  may  prove  useful  to  receive  and  protect  the  intes- 
tines in  case  they  should  protrude  too  extensively. 

The  animal  is  placed  in  the  decubital  position  on  his  back, 
with  the  leg  of  the  affected  side  maintained  in  abduction.  Anes- 
thetics are  generally  used,  especially  when  there  are  fears  of  com- 
plications, while,  in  fact,  they  ought  never  to  be  omitted.  The 
operator  then,  with  the  convex  bistoury,  makes  carefully,  on  the 
inferior  border  of  the  hernial  sac,  an  antero-posterior  incision, 
parallel  to  the  median  raphe  of  the  scrotal  region,  cutting  through 
the  skin,  the  dartos  and  the  first  layer  of  the  cellular  tissue  under- 
neath. He  then  with  his  hands  tears  the  adhesions  which  exist 
between  the  dartos  and  the  tunica  erythroidea,  in  order  to  enucle- 
ate the  hernial  tumor  in  its  entirety.  This  step  is  easily  effected 
when  the  cellular  tissue,  which  covers  the  fibrous  coat,  is  not  in- 
durated, but  if  that  should  be  the  case  when  adhesions  exist,  the 


HERNIA.  417 

dissection  should  be  carefully  made  with  the  knife  until  the  ad- 
hesions are  completely  divided  and  the  fibrous  coat  fully  exposed. 
The  reduction  must  then  be  attempted  without  opening  the  sac, 
and  in  the  absence  of  any  adhesions  this  is  effected  without  diffi- 
culty, the  inguinal  opening  being  so  large  that,  through  the  force 
of  mere  gravitation,  the  dorsal  position  in  which  the  animal  is 
placed  is  often  sufficient  in  itself  to  cause  the  return  of  the  intes- 
tines into  the  abdominal  cavity,  even  the  testicle  and  the  hernial 
sac  often  following  it  in  its  inward  movement. 

If  the  reduction  does  not  take  place  in  this  manner,  or  in  con- 
sequence of  the  position  of  the  animal,  the  taxis,  both  scrotal 
and  rectal,  is  then  indicated  to  be  performed  in  the  same  manner 
as  for  acute  hernia.  Difficulties  in  effecting  this  reduction  may 
arise  from  three  causes — either,  first,  the  bulk  of  the  mass  repre- 
sented by  the  protruding  intestines ;  or  second,  its  obstruction ; 
or  third,  the  adhesions  which  it  may  have  contracted  with  the 
walls  of  the  sac  or  with  the  spermatic  cord. 

To  obviate  the  first  difficulty,  while  the  manipulations  of  the 
taxis,  scrotal  and  rectal  are  simultaneously  continued,  it  will 
be  weU  to  relieve  the  position  of  the  animal,  and  instead  of  keep- 
ing him  lying  absolutely  on  his  back,  to  allow  him  to  turn 
shghtly,  and  to  rest  on  the  side  opposite  the  hernia.  In  this 
way  the  mass  will  not  be  so  heavy  to  manipulate,  and  wiU  be  in  a 
better  position  to  follow  the  dependent  dii-ection  in  which  it 
must  be  pushed  by  the  scrotal  taxis,  while  at  the  same  time,  by 
the  rectal  manipulation,  it  can  be  more  easily  unfolded  and  drawn 
from  the  cavity  in  which  it  was  imprisoned.  But  if,  notwithstand- 
ing aU  these  precautions,  this  diffictdty  in  the  reduction  cannot  be 
overcome,  the  indication  of  opening  the  sac  still  remains. 

The  incision  of  the  sac  is  performed  as  in  cases  of  recent 
hernia,  the  bed-sheet  already  mentioned  being  held  in  readiness 
to  receive  the  intestinal  mass  as  it  will  be  exposed.  Then  the 
animal  being  completely  under  the  influence  of  ether,  and  in  the 
dorsal  position,  an  assistant  grasps  the  edges  of  the  sac  and 
stretches  them  apart,  funnel-wise,  using  both  hands  alternately, 
gradually  pushes  the  intestines  towards  the  hernial  opening,  an 
assistant  at  the  same  time  slowly  unfolding  the  mass  and  permit- 
ting it  to  slide  into  the  abdominal  ca\dty. 

Rectal  taxis  may  largely  assist  in  this  step  of  the  operation. 

If  the  redviction  is  rendered  impossible  by  the  interposition  of 


418  OPERATIONS    ON    THE    DIGESTIVE    APPARATUS. 

obstructions,  the  first  indication  will  be  to  evacuate  the  intestines 
by  a  methodical  pressure  which  will  displace  the  alimentary  mass 
and  return  it  toward  the  abdomen.  The  puncture  made  with  the 
aspirator  has  proved  very  beneficial  in  these  compHcations. 

The  adhesions  require  the  most  careful  dissection,  especially 
when  they  are  short,  and  when  both  the  visceral  and  parietal 
layers  of  peritoneum  are  closely  imited.  The  separation  must  be 
done  by  a  succession  of  short,  limited  incisions,  at  the  expense  of 
the  thickness  of  the  parietal  layer. 

A\Tien  strangulation  of  chronic  hernia  occurs,  it  is  due  not  to 
want  of  room  at  the  hernial  ring,  but  to  the  enlarged  bulk  of  the 
protruding  organ,  which  constitutes  the  obstruction.  Conse- 
quently the  indication  for  herniotomy  is  not  present.  On  the 
contrary,  as  serious  eventration  is  always  to  be  feared,  the  only 
indication  is  the  removal  of  the  obstruction  as  akeady  indicated. 

"SMien  the  reduction  has  been  completed,  the  occlusion  of  the 
vaginal  sac  is  to  be  obtained  by  the  application  of  the  clamp, 
ajDplied  as  high  up  as  possible,  as  in  cases  of  strangulated  acute 
hernia. 

In  cases  of  inguinal,  complicated  with  ventral  hernia,  attempts 
at  reduction  may  be  made  by  placing  a  long  clamp  over  the  cov- 
erings of  the  latter,  invohing  with  them  the  hernial  sac  and  its 
cutaneous  envelope,  as  practiced  in  some  cases  of  the  umbilical 
form. 

"We  need  but  briefly  to  refer  to  certain  different  modes  of  treat- 
ment of  the  various  forms  of  hernia  by  the  use  of  bandages,  rec- 
ommended by  Petard,  Grau,  Klinger  and  Marlot,  together  with 
the  application  of  sutures  upon  the  edges  of  the  inguinal  canal, 
patronized  by  Hertwig  and  Dieterichs,  to  say  that  none  of  these, 
any  more  than  some  others,  borrowed  from  human  surgery,  can 
give  more  satisfactory  results,  or  be  employed  with  greater  safety, 
and  effect  a  radical  cure  better  than  the  use  of  the  clamp  and  the 
castration  by  the  process  of  the  covered  testicle. 

Inguinal  Hernia  in  Geldings. 

Although  inguinal  hernia  in  the  gelding  is  certainly  less  com- 
mon than  in  the  staUion,  it  is  not,  therefore,  of  impossible  occur- 
rence. But  from  the  fact  of  its  rare  appearance  it  is  far  more 
likely  to  be  overlooked,  and  therefore  neglected,  with  similar  fatal 


HERNIA.  419 

results  to  those  iu  the  stallion,  when  it  reaches  the  stage  of 
strangulation. 

From  the  fact  that,  as  the  result  of  castration,  the  superior 
opening  of  the  testicular  sheath  is  more  or  less  closed,  it  becomes 
a  matter  of  rational  inference,  that  hernia  in  a  gelding  is  not  of 
posterior  occurrence  to  castration,  but  that  its  existence  is  due  to 
a  congenital  disposition,  and  that  by  the  operation  of  gelding  they 
have  been  reduced  to  their  smallest  proportions,  in  relation  to  the 
dimensions  of  the  intra-vaginal  sac,  to  the  dimensions,  in  fact, 
of  a  bubonocele,  which  continues  imobserved  in  consequence  of  the 
smallness  of  its  size,  and  the  depth  of  its  location. 

These  hernias  are  detected  outwardly  by  a  physical  symptom, 
to  wit,  the  existence  in  the  inguinal  region,  on  either  side  of  the 
penis,  and  above  the  cicatrix  of  castration,  of  a  tumor  about  the 
size  of  an  egg,  soft,  depressible,  altogether  painless,  sometimes 
elastic  and  at  times  puffy.  It  varies  much  in  size,  diminishing 
with  rest  and  quiet,  and  increasing  with  effort  and  active  move- 
ment. It  may,  in  fact,  under  the  first  condition,  entirely  disap- 
pear, to  return  as  soon  as  the  animal  is  put  to  work.  In  a  word, 
it  has  the  true  character  of  being  intermittent.  Aside  from  these 
symptoms,  rectal  exploration  fui-nishes  positive  data  of  its  exist- 
ence, by  the  abnormal  dilatation  of  the  ring,  easily  detected,  and 
by  the  pressure  of  the  intestines  lodged  in  it. 

This  hernia  is  also  susceptible  of  strangulation,  and  is  then  ac- 
companied by  violent  abdominal  pains,  which  must  not  be  ignored 
as  to  then-  possible  diagnosis  and  significance.  The  indication 
for  careful  examination  in  that  direction  must,  indeed,  never  be 
overlooked  in  cases  of  violent  coUcs  in  geldings.  If  these  colics 
are  due  to  strangulated  hernias,  the  presence  of  a  round,  tense, 
resistant  and  painful  tumor  will  be  detected  in  either  of  the  in- 
guinal regions,  and,  according  to  Bouley,  more  commonly  on  the 
left  than  on  the  right  side.  The  strangulation  in  this  class  of 
hernia  is  generally  ii-reducible,  and  becomes  rapidly  fatal ;  if  not 
reheved  immediately,  it  is  not  reheved  at  all. 

The  first  indication  of  treatment  is  the  reduction  of  the  hernia 
by  simple,  external  taxis,  or  by  combining  with  it  the  rectal  taxis. 
The  reduction  will  be  followed  by  the  disappearance  of  all  the 
symptoms,  and  the  animal  will  be  apparently  well,  until  a  second 
attack  takes  place.  After  the  reduction,  steps  must  be  taken  to 
prevent  its  return,  by  an  operation  similar  to  one  of  those  used  in 


420  OPERATIONS    ON    THE    DIGESTIVE    APPARATUS. 

umbilical  hernia,  to  obtain  the  reduction  and  retention  of  the  in- 
testine, by  the  appUcation  of  a  proper  clamp  upon  the  sac  cov- 
ered by  the  scrotal  skin. 

The  treatment  of  the  gelding  for  strangulated  hernia  does  not 
differ  from  that  of  the  stallion.  Ordinarily,  the  taxis  is  sufficient 
to  reduce  such  complicated  hernia,  but  in  case  of  failure  in  obtain- 
ing rapid  success  one  must  be  careful  not  to  carry  on  the  manipu- 
lations so  long  as  to  encounter  the  risk  of  lacerating  or  tearing 
the  tissues.  The  wiser  and  safer  plan  will  then  be  to  have  recourse 
to  the  operation  of  herniotomy,  an  operation  which  should  be 
performed  with  the  greatest  care  in  separating  and  dividing  the 
existing  cicatricial  adhesions  of  castration.  The  clamp  is  after- 
wards placed  ui^on  the  hernial  sac,  with  its  cutaneous  covering, 
requiring  a  longer  time  to  slough,  and  constituting  a  means  of 
retention  most  favorable  to  the  success  of  the  oj)eration. 

Ckukal  Hernia, 

or  merocele,  is  that  form  of  rupture  in  which  the  abdominal 
organs  make  their  escape  through  the  crural  ring.  It  is  a  rare 
affection  among  our  domestic  animals,  but  has  been  seen  by  La- 
fosse,  Jr.,  in  the  horse,  by  Girard,  Jr.,  in  the  dog,  by  Dandrieu  in 
cows,  and  by  Hertwig  in  horses,  donkeys  and  dogs.  It  is  said  to 
be  more  frequent  in  males  than  females.  It  results  from  violent 
muscular  efforts,  and  especially  from  the  slipping  apart  of  the  legs 
when  already  separated  or  straddling  in  abduction.  It  is  char- 
acterized by  a  somewhat  well  defined  tumor,  of  moderate  size, 
situated  behind  the  inguinal  ring,  towards  the  middle  of  the  flat 
part  of  the  thigh.  When  the  rupture  is  recent,  the  animal  is  some- 
what stiff  in  his  gait,  especially  on  the  affected  side,  and  carries 
his  leg  in  abduction.  There  is  also  a  degree  of  lameness.  Accord- 
ing to  Hertwig,  the  tumor  is  easily  reduced,  and  not  very  painful. 
In  a  few  cases  it  may  be  complicated  with  strang-ulation.  The 
organs  which  have  been  found  in  the  sac  have  been  portions  of 
the  small  intestines ;  the  omentum,  a*s  reported  by  Hertwig,  and  the 
bladder,  in  one  cow,  according  to  Dandrieu.  The  progiiosis  in 
cases  which  receive  early  attention,  is  not  serious. 

The  treatment  consists  in  reducing  the  rupture,  and  afterwards 
closing  the  passage  through  which  it  occurred.  This  is  effected 
by  making  an  incision  through  the  skin  over  the  tumor,  and  closing 


HERNIA.  421 

the  ring  with  a  few  stitches  upon  Poupart's  Hgament  and  the  small 
adductor  of  the  leg.  A  good  bhster  rubbed  over  the  enlargement 
completes  the  treatment.  According  to  Zundel,  three  weeks  of 
subsequent  rest  are  required  to  assure  recovery. 

Pekineal  Heknia. 

This  is  a  very  rare  lesion  and,  as  Zundel  describes  it,  is  the  pas- 
sage of  the  peritoneum  and  viscera  through  the  vascuio-aponeur- 
otic  floor  of  the  bottom  of  the  pelvis.  It  is,  however,  reported  to  be 
common  in  dogs,  in  which  animal  it  is  situated  between  the  ischium, 
the  sacrum,  the  anus  and  the  urethra,  and  is  often  mistaken  for  an 
abscess.  It  is  more  frequently  formed  by  the  bladder  than  by  the 
intestines. 

Pancreatic  Hernia. 

This  hernia  was  first  observed  by  Prinz,  and  afterwards  noticed 
by  Husson,  Koell,  and  others.  It  is  caused  by  the  strangulation 
of  the  jejunum  and  the  anterior  part  of  the  ileum  through  the 
hiatus  of  Winslow,  the  orifice  above  the  right  angle  of  the  pan- 
creas, and  of  the  vena  cava,  in  front  of  the  right  kidney.  It  is 
accompanied  by  symptoms  of  intestinal  congestion,  and  cannot  be 
reached  by  any  form  of  treatment,  if  indeed  it  can  be  accurately 
diagnosed  during  life. 

Pelvic,  or  Internal.    Hernia  of  Oxen. 

This  form  of  hernia  is  pi'incipally  described  by  Zundel,  from 
whom  we  extract  the  following  :  "  It  is  the  strangulation  of  a  loop 
of  intestines,  which  has  pushed  through  the  ruptured  peritoneum, 
from  before  backward,  between  the  testicular  cord  and  the  lateral 
wall  of  the  pelvis,  the  rupture  of  the  peritoneum  having  resolved 
during  some  of  the  manipulations  of  castration  from  excessive 
stretching  of  the  cord,  as  in  the  operation  by  tearing.  It  is,  there- 
fore, exclusively  a  lesion  of  the  ox,  and  cannot  affect  the  bull.  It 
is  quite  common  in  Germany,  and  has  been  met  with  in  England, 
Mecklenburg  and  Alsace.  It  was  first  described  by  Oesterten,  in 
1811,  followed  by  Anker  in  1824,  and  later  by  Zundel,  Ostertag 
and  Tues.  It  is  comparatively  often  seen,  and  in  many  cases  over- 
looked. The  first  intimation  of  the  presence  of  the  disease  appears 
in  the  onset  of  symptoms  of  a  violent  attack  of  colic.  The  animal 
becomes  anxious  and  restless,  Hes  down  hastily  and  rises  again 


422  OPERATIONS    ON    THE    DIGESTIVE    APPARATUS. 

suddenly;  turns  about,  moves  to  and  fro,  lashes  with,  his  tail,  and, 
in  a  word,  betrays  all  the  usual  signs  of  intense  suffering,  and  it 
becomes  difficult,  if  not  dangerous,  to  approach  him  in  order  to 
make  a  proper  examination.  The  temperature  of  the  body  is  ele- 
vated, there  is  some  perspiration,  the  nose  is  hot,  though  still 
moist ;  both  respiration  and  circulation  are  accelerated.  The  ani- 
mal refuses  food  or  drink,  rumination  is  suspended,  and  though 
defecation  has  not  ceased,  the  faeces  are  hard,  blackish  and  coated. 

In  from  six  to  twelve  hours,  this  state  of  febrile  excitement 
subsides,  and  the  animal  becomes  dull  and  quiet,  gazing  towards 
its  flanks,  the  ears  dropping,  the  hind  leg  corresponding  to  the 
side  of  the  hernia  is  extended  backward,  and  at  the  same  time  the 
lumbar  region  is  relaxed  downward.  If  the  animal  is  lying  down 
he  may  remain  quiet  for  a  while,  with  his  hind  leg  still  extended, 
but  will  presently  spring  to  his  feet  with  his  back  arched  as  before, 
at  the  lumbar  region,  but  which  drops  again  and  straightens  im- 
mediately. When  he  walks  it  is  with  a  stiff  action,  principally 
towards  the  diseased  side ;  the  extremities  are  cool,  the  pulse  is 
small  and  insensible,  respiration  is  accelerated  ;  constipation  at 
length  becomes  complete  with  mucous  and  bloody  passages,  per- 
haps accompanied  with  flatulence,  but  micturition  is  still  easy. 

Two  or  three  days  later  there  are  other  changes.  The  period 
of  calm  terminates,  and  is  succeeded  by  a  season  of  alternating 
agitation  and  repose — action  and  reaction  of  the  fluctuating  in- 
flammatory process. 

The  animal  now  and  then  utters  grunts  of  pain,  his  pulse  be- 
comes smaller,  and  is  at  length  imperceptible,  and  all  the  un- 
favorable manifestations  are  exaggerated.  Either  gangrene  has 
supervened,  or,  as  some  would  judge,  enteritis,  and  all  the  symjv 
toms  point  towards  the  more  fatal  termination. 

It  is  only  by  rectal  examination  that  the  diagnosis  can  be- posi- 
tively established,  and  when  this  has  been  carefully  and  success- 
fully made,  he  will  have  discovered  what  may  be  thus  described  : 
a  puffy  mass,  indefinite  as  to  size,  situated  usually  nearer  the 
sacrum  than  the  pubis,  on  the  side  of  which,  generally  the  right, 
a  portion  of  the  intestines  has  sHpped  under  the  testicvdar  cord — 
this  being  the  definition  of  a  crural  hernia.  It  may  be  a  simple 
protrusion  of  the  intestine,  and  again,  this  maybe  twisted  around 
the  spermatic  cord,  a  condition  particularly  likely  to  terminate  in 
strangulation. 


HERNIA.  423 

This  lesion  may  continue  as  long  as  nine  days,  four  to  five 
being  the  average  duration,  and  it  may  terminate  by  spontaneous 
reduction,  but  the  trustful  surgeon  who  too  confidently  and  too 
often  expects  to  find  that  Nature  has  dispensed  with  his  aid  in 
this  kindly  way,  is  doomed  to  encounter  many  disappointments. 
Or  it  may  end  in  gangrene  or  enteritis. 

The  fact  that  the  disease,  if  not  interfered  with,  may  terminate 
fatally  in  so  brief  a  period  as  five  days,  of  course  renders  the 
prognosis  quite  a  serious  one,  unless  the  nature  of  the  ailment 
has  had  an  early  identification  and  measures  have  been  taken  to 
avert  the  danger.  The  gravity  of  the  prospect  is,  of  course,  in- 
creased when  the  complication  with  strangulation  or  enteritis,  as 
before  mentioned,  enters  into  the  case. 

The  treatment,  as  in  other  cases,  consists  in  the  reduction  of 
the  hernia.  With  a  small  proportion  of  patients  this  may  be 
effected  by  the  simple  act  of  causing  the  animal  to  walk  down  a 
steep  decHvity — a  sort  of  spontaneous,  or  semi-spontaneous  cure, 
from  which,  although  founded  on  anatomical  principles,  too  much 
must  not  be  confidently  expected.  We  copy  from  Zundel  his  de- 
scription of  other  and  more  scientific  methods : 

(«)  Reduction  by  Simple  Taxis. — The  animal  is  placed  on  an 
incHned  plane,  with  his  hind-quarters  raised,  and  an  assistant  on 
one  side  of  him  ready,  at  a  given  moment,  to  press  on  the  loins. 
The  operator,  with  his  hand  in  the  rectum,  searches  for  the  in- 
testinal loop,  and  when  he  has  found  it,  holding  it  in  the  bottom 
of  his  hand,  he  feels  for  the  opening  under  the  spermatic  cord, 
which  he  dilates  with  his  fingers,  and  now,  while  the  assistant 
presses  hard  on  the  loins,  as  just  mentioned,  the  intestine  may 
be  readily  felt  moving  downward  and  forward  under  the  cord,  to 
resume  its  normal  position.  -Although  simple,  and,  in  the  ma- 
jority of  cases,  successful,  this  mode  has  the  defect  of  leaving  the 
animal  exposed  to  a  return  of  the  hernia. 

{h)  Reduction  by  Laceration  of  the  Cord  through  the  Rectmyi. 
— This  method  is  recommended  by  Metzger,  Eisele,  Schenck, 
Gierer  and  Ostertag.  It  consists  in  tearing  away  the  adhesions 
formed  by  the  stump  of  the  cord  after  castration,  and  loosening 
it  from  the  inguinal  ring.  It  is,  however,  difficult  to  do,  and  not 
without  danger.  The  hand  being  introduced  into  the  rectum, 
and  the  opening  found,  the  fingers  are  closed  in  the  form  of  a 
wedge,  and  with  a  sHght  movement  of  rotation  pushed  through 


424  OPERATIONS    ON    THE    DIGESTIVE    APPAEATUS. 

the  opening,  and  tlie  cord  thus  separated  from  its  adhesions. 
After  a  "while,  the  pressure,  which  was  quite  firm  at  first,  dimin- 
ishes, and  the  intestine  gradually  returns  to  its  position.  This 
mode  is  slow  in  its  steps,  but  it  is  successful  in  its  results,  even 
in  cases  of  obstruction  and  of  strangulation.  ^Tien  it  faOs,  it  is 
because  of  the  strength  of  the  adhesions  between  the  cord  and 
the  abdominal  walls,  or  the  inguinal  canal. 

(c)  Division  of  the  Stricture  through  the  Rectum. — To  per- 
form this  operation,  invented  by  Schmidt,  a  trocar  about  sixty- 
five  centimeters  (some  thirty-five  inches)  long  is  necessary.  This 
trocar  has  its  j)oint  attached  with  a  screw,  in  order  to  permit  its 
removal  and  the  substitution  of  a  blunt  bistoury.  "With  the  left 
hand  in  the  rectum,  a  fold  of  that  intestine  is  secured  a  little  be- 
hind the  point  of  stricture,  and  the  trocar  pushed  through  it. 
The  stylet  of  the  instrument  being  then  withdrawn,  leading  the 
canula  in  place,  the  jDoint  of  the  trocar  for  the  bistoury  is  then 
inserted,  while  the  hand,  still  in  the  rectum,  leaves  the  rectal  fold 
loose,  feels  for  the  spermatic  cord,  raises  it  and  guides  the  bis- 
toury against  it,  which  with  comparative  ease  completes  the  di- 
vision of  the  stricture. 

{d)  Division  of  the  Stricture  after  Incision  of  the  Flank. — 
Through  an  incision  made  in  the  middle  of  the  right  flank,  the 
hand  is  introduced  and  grasps  the  spermatic  cord,  which  is  then 
divided  with  a  bistomy  cache,  oi',  which  is  better,  with  the  inside 
edge  of  a  hook  kejjt  sharp,  similar  to  the  hook  used  in  some  cases 


—Sharp  Hook  for  the  Section  of  the  Testicular  Cord. 


of  distokia.  The  hernia  being  reduced,  and  the  wound  in  the 
flank  brought  together  with  sutures,  a  circular  bandage  is  apphed 
around  the  abdomen.  "With  the  reduction  of  the  hernia,  what- 
ever may  have  been  the  means  of  accomplishing  it,  the  symptoms 
subside,  and  the  treatment  is  completed  by  the  administration 
of  laxatives  or  sedatives,  rectal  injections,  etc.,  as  the  indications 
may  require. 


425 


Umbilical  Heenia. 


Umbilical  hernia  is  the  protrusion  through  the  non-obliter- 
ated umbilical  ring  of  either  the  omentum  or  the  small  intestine, 
or  both.  It  is  also  known  as  an  exomphalus  or  omplialocele.  It 
receives  the  name  of  enteromphalus  or  epijjloin^yhalus  when  formed 
by  the  displacement  of  the  intestines,  or  that  of  the  omentum 
separately,  and  when  both  of  those  organs  are  implicated  it  be- 
comes an  entero-epip>lomphalus.  UmbiUcal  hernia  is  quite  com- 
mon in  horses  and  dogs,  not  less  so  in  bovines,  and  has  been  no- 
ticed in  swine  and  sheep.  It  is  most  common  in  young  animals, 
especially  soon  after  birth,  is  at  times  congenital,  and  may  be  long 
continued,  even  to  adult  age,  or  for  eight,  ten  or  twelve  years. 

Umbilical  hernias  are  either  congenital  or  accidental.  The 
former  are  formed  during  foetal  life  and  continue  at  birth,  al- 
though, according  to  some  authors,  they  are,  strictly,  not  so 
much  congenital  as  accidental,  and  are,  in  fact,  the  result  of  the 
pulling  and  stretching  of  the  umbilical  cord  during  the  act  of  de- 
livery. However  this  may  be,  they  do  usually,  in  fact,  make  their 
appearance  during  the  second  and  third  months  following  birth, 
when  through  the  persistency  of  the  oj^ening,  and  the  imperfec- 
tion of  the  umbilical  cicatrix,  the  intestines  are  enabled  to  pro- 
trade  through  the  ring,  and  subsequently  to  firevent  its  closing 
by  their  presence.  But  again,  while  the  cicatrix  is  weak,  the  ac- 
tive exercise  and  forcible  movements  of  the  young  animal  while  at 
play  may  cause  the  rupture  ;  and  still,  again,  the  protrusion  may 
be  caused  by  intestinal  derangements.  Indeed,  all  traumatic 
causes,  such  as  contusions,  blows,  and  any  violent  efforts  taking 
place  during  the  period  of  consolidation  of  the  closing  cicatricial 
tissue,  may  become  an  originating  cause  of  this  lesion.  Animals 
of  low  and  lymphatic  constitution  are  much  predisposed  to  this 
trouble,  especially  such  as  feeble  colts,  born  of  mares  badly  cared 
for  and  insufficiently  fed  during  gestation.  Heredity  fills  a  large 
place  among  the  predisposing  causes  in  low-conditioned  mares  with 
feeble  organizations,  and  suffering  with  similar  trouble  when  young, 
dams  of  this  class  naturally  bringing  forth  foals  of  defective  stam- 
ina, liable  to  perpetuate  the  same  constitutional  tendencies. 

The  symptoms  of  umbilical  hernia  are  generally  exclusively 
local.  It  is  characterized  by  a  semi-globular  or  pyriform  tumor 
situated  on  the  median  line  of  the  abdomen  at  the  umbihcal  ring, 


426  OPEEATIONS    ON    THE    DIGESTIVE    APPARATUS. 

and  varyiBg  in  dimensions  from  the  size  of  a  lien's  egg  to  that  of 
a  child's  head — dimensions  which  may  vary  according  to  the  con- 
dition of  vacuity  or  fullness  of  the  intestine  ;  the  position  of  the 
animal,  whether  standing  or  l}ang,  or  according  to  the  length  of 
time  it  may  have  existed.  The  consistency  of  the  tumor  is  very 
variable.  It  may  be  soft,  easily  depressed  by  the  finger  ;  elastic, 
when  distended  with  gases ;  or  soft  and  puify  when  containing 
alimentary  matter — these  changes  being  accounted  for  by  the  na- 
ture of  the  organ.  An  enteromphalus  will  give  the  sensation  of 
an  elastic  mass,  while  the  epij^lomphalus  will  form  a  puffy  swell- 
ing. This  species  of  hernia  is  almost  always  painless,  and  exhib- 
its as  one  of  its  pecuHar  and  constant  symptoms  the  character  of 
being  reducible.  In  the  generality  of  cases,  it  can  be  made  to 
disappear  temporarily  by  the  taxis  and  by  forcing  the  protruding 
portion  back  into  the  abdomen,  but  only  to  reappear  at  once  as 
soon  as  the  pressure  is  withdrawn,  especially  if  the  animal  is  on 
his  feet.  On  being  thus  reduced,  the  opening  of  the  ring  can 
readily  be  detected,  and  the  fingers  may  be  freely  introduced 
through  its  diameter  and  its  form  and  dimensions  ascertained 
shewing  it  to  be  sometimes  elliptic,  sometimes  circular,  and  some- 
times irregular,  the  originating  cause  of  the  hernia  itself  deter- 
mining the  difference. 

Besides  these  more  common  symptoms  of  umbilical  hernia, 
there  are  others  which  can  be  detected  by  more  careful  examina- 
tion. For  instance,  on  appljdng  the  hand  over  the  tumor,  the  ver- 
micular motions  of  the  intestines  may  be  recognized,  and  by  feel- 
ing in  the  hernial  sac,  the  presence  of  faecal  masses  may  be  discov- 
ered ;  and  it  may  be  possible  by  auscultation  even  to  detect  the 
presence  of  borborygmus  through  the  displaced  intestines,  and 
even  to  observe  its  true  nature,  by  reason  of  the  transparency  of 
the  sac  and  its  envelopes.  These  are  the  most  ordinary  symp- 
toms of  an  exomphalus,  although  it  is  subject  to  complications, 
and  the  symptomology  will  vary  accordingly. 

There  are  cases,  but  they  are  rare,  in  which  the  hernia  be- 
comes irreducible.  The  most  serious  of  these  are  such  as  are 
found  to  have  become  so  in  consequence  of  the  formation  of  ad- 
hesions between  the  protruding  organ  and  the  hernial  sac — a  very 
infrequent  occurrence.  The  most  common  cause  will  be  the  pres- 
ence of  undigested  masses  of  food  accumulated  in  the  intestines, 
such  as  hard  balls  of  faeces  or  sand. 


HERNIA.  427 

Inflammation  of  umbilical  hernia  may  follow  blows  or  bruises, 
though  such  a  result  from  these  accidents  is  not  a  common  one, 
and  its  occurrence  will  naturally  be  accompanied  with  changes 
in  the  appearance  of  the  tumor,  such  as  the  usual  phenomena 
attending  inflammatory  action,  as  increase  of  temperature,  ten- 
derness or  pain,  cedema,  etc.,  which  may  even  at  times  so  com- 
bine their  effects  as  to  render  the  hernia  irreducible.  Engorge- 
ments and  strangulations,  however,  are  very  rare  comphcations 
of  this  form  of  hernia,  a  fact  easily  understood  when  it  is  con- 
sidered that  the  neck  of  the  hernial  sac  is  formed  by  the  umbihcal 
ring  itself. 

An  exomphalus  is  usually  an  affection  of  httle  gravity,  and 
often  disappears  spontaneously,  or  if  it  persists  after  the  period 
of  weaning,  is  easily  radically  cured  when  the  animal  grows  and 
develops.  Yet  even  if  undisturbed  and  unchanged,  they  persist 
in  remaining,  their  existence  is  not  incompatible  with  j)erfect 
health  and  full  ability  to  labor,  however  they  may  reduce  the  com- 
mercial value  of  the  animal.  They  are  less  injurious  to  young 
animals  than  to  adults,  and  less  dangerous  when  small  than  when 
assuming  large  dimensions.  When  simple,  they  are  easily  amen- 
able to  treatment,  but  if  compHcated  they  become  dangerous,  es- 
pecially so  when  the  capacity  of  the  ring  is  so  disproportioned  to 
the  dimensions  of  the  protruding  intestines  that  strangiilation  be- 
comes an  accident  of  easy  occurrence.  Reducible  hernia  is  at- 
tended with  but  little  hazard,  while  the  danger  arising  from  the 
possible  formation  of  adhesions  in  cases  which  have  passed  into 
the  irreducible  class  becomes  a  matter  of  very  serious  import. 

If  it  is  an  admitted  fact  that  animals  suffering  with  umbilical 
hernia  do  often  recover  spontaneously,  the  recovery  being  a  normal 
incident  of  the  natural  development  of  the  animal,  due  to  changes 
of  position  in  the  abdominal  contents,  not  to  specify  other  effi- 
cient causes ;  then  the  question  of  immediate  or  early  interfer- 
ence undoubtedly  receives  and  justifies  a  negative  answer.  Our 
own  testimony  is  that  we  know  of  cases  where  patient  waiting, 
even  for  a  period  of  twelve  months,  has  been  rewarded  by  the 
radical  disappearance  of  the  hernia.  But  the  objections  to  such 
long  waiting  are  of  a  tangible  and  serious  nature,  and  surgical 
interference  becomes  imperative  and  indispensable.  The  persons 
are  few  who  are  able  or  willing  to  nurse  an  idle  horse  for  a  year 
for  the  sake  of  saving  him  from  the  pain  of  an  operation. 


428  OPERATIONS    ON    THE    DIGESTIVE    APPARATUS. 

The  object  of  all  treatment  is,  of  course,  the  reduction  and  re- 
tention of  the  hernia,  but  the  means  of  doing  so  are  various. 
They  are  mainly  included  under  four  heads.  The  first  method  is 
by  bandages  /  the  second,  by  external  or  topical  applications  / 
the  third,  by  surgical  operations  for  the  co7istriction  of  the  tumor; 
and  the  fourth,  such  special  treatment  as  may  be  required  to  meet 
complications. 

1st.  Bandages. — The  bandage  of  retention  is  essentially  a  belt 
buckled  around  the  body,  by  w^hich  a  pad  is  kept  over  the  oj)en- 
ing  of  the  umbilicus  to  prevent  the  escape  of  the  abdominal  con- 
tents, and  temporarily  perform  their  office  in  the  subcutaneous 
hernial  sac.  It  is  designed  to  aid  in  the  mechanical  closing  of  the 
umbilical  opening  until  that  takes  place  by  the  process  of  physio- 
logical change  in  the  sac  and  its  borders. 

The  forms  of  bandage  in  use  are  many  and  various,  among  which 
Peuch  and  Toussaint  name  four  princij^al  kinds.  A  most  import- 
ant requisite  in  all  of  them  is  that  while  they  possess  the  sohdity 
and  fixity  necessary  to  retain  the  reduced  hernia  in  j)lace,  they 
shall  cause  the  minimum  amount  of  discomfort  to  the  patient. 

The  bandage  of  Marlot,  according  to  Zundel,  is  the  one  which 
best  fulfills  the  three  conditions  of  solidity,  fixity  and  elasticity. 
It  consists  of  a  kind  of  padded  saddle,  with  straj)s  at  its  four 
corners,  buckling  on  two  belts,  the  anterior  or  p>ectoral,  which  sur- 
rounds the  chest  like  a  girth,  and  the  posterior  or  ventral,  which 
presses  the  retaining  pad  against  the  umbilicy.  This  pad  is  a 
wide  hair  cushion  of  a  moderate  thickness,  kejDt  in  place  and  pre- 
vented from  slipping  back  by  a  longitudinal  girth  connecting  the 
pectoral  and  the  ventral  belts. 

The  bandage  of  Massicra  is  much  recommended  in  Italy.  This 
also  is  a  small  saddle  with  two  wide  girths  passing  under  the 
thorax,  and  pressing  against  the  sternum  and  the  ei^igastric  re- 
gion, with  a  steel  band  corresponding  at  its  posterior  extremity 
with  the  umbilical  ring,  forming  a  plate  padded  with  a  hair  cushion. 

The  apparatus  of  Strauss,  used  in  Germany,  is  made  somewhat 
on  the  same  principle,  but  is  reinforced  by  a  kind  of  breeches 
which  prevents  it  from  slipping  backward. 

The  length  of  time  necessary  for  a  patient  to  wear  a  bandage 
will  vary  with  the  dimensions  of  the  hernia — from  one  to  three 
months,  according  to  Lafosse,  being  required  to  obtain  a  radical 
cm-e.     Marlot  claims  that  an  average  of  thirty-two  days  is  all  that 


HEENIA.  429 

is  necessary.  The  bandages  must  be  applied  only  after  the  perfect 
reduction  of  the  hernia,  and  the  most  accurate  adaptation  of  the 
pad  to  the  umbilical  opening.  These  appliances  are  of  difficult 
adjustment  and  are  unavoidably  uncomfortable  to  the  animal  from 
their  liability  to  chafe  and  excoriate  the  skin.  They,  therefore, 
constitute  a  mode  of  treatment  which  must  necessarily  be  attended 
with  uncertainty,  and,  therefore,  as  justifying  only  a  careful  and 
modified  recommendation.  Still,  it  has  in  the  hands  of  many  prac- 
titioners given  very  satisfactory  results. 

2d.  Local  Applications. — The  treatment  by  irritating  local  med- 
ication aims  to  produce  in  the  tissues  surrounding  the  hernial  sac 
an  inflammation  which  will  end  in  a  serous  infiltration  which  will 
crowd  away  the  protruding  organ,  prevent  its  return  into  the  open- 
ing, and  subsequently  facilitate  the  obHteration  of  both  the  sac 
and  the  ring.  This  result  is  obtained  by  the  use  of  certain  chem- 
ical agents,  which  applied  on  the  hernial  tumor  tend  to  produce 
various  degrees  of  inflammation,  from  simple  rubefaction  to  com- 
plete escharification  of  tissues.  In  former  times  sulphuric  acid  was 
recommended,  and  as  late  as  1833,  Hertwig  employed  it  in  appli- 
cations made  dviring  two  or  three  days.  Blisters  and  their  con- 
geners have  had  their  day.  Astringents  have  also  been  recom- 
mended, as  also  caustics,  principally  in  the  form  of  oratments,  as 
that  of  chromate  of  potash,  in  the  proportion  of  one  part  in  eight, 
as  recommended  by  Foelen — these  also  have  had  their  advocates. 
But  of  all  these,  nitric  acid,  applied  externally,  is  the  one  which 
has  proved  most  satisfactory  and  least  dangerous. 

The  treatment  consists  ia  applying  acid  upon  the  tumor  of  the 
exomphalus,  in  sufficient  quantity  to  produce  an  escharotic  effect, 
and  afterwards  promote  the  sloughing  of  the  cutaneous  sac.  The 
mode  is  thus  described :  After  positive  diagnosis  of  the  nature 
and  character  of  the  tumor,  the  animal  being  kept  in  the  standing 
posture,  the  hairs  cut  short,  the  acid  is  applied  over  the  entire  sur- 
face of  the  sac,  by  rubbing  it  in  with  a  brush,  or  a  small  ball  of 
oakum  secured  at  the  end  of  a  stick,  and  dipped  into  the  acid — 
which  should  register  34"  to  36°  Baume — first  passing  it  circularly 
over  the  base  of  the  examphalus  to  define  the  place  where  its  action 
is  required,  and  then  including  the  entii'e  surface.  A  sufficient 
quantity  of  the  caustic  must  be  applied,  and  with  enough  energy 
to  produce  the  disorganization  of  the  skin  in  its  entire  thickness, 
and  positively  produce  its  mortification.     Experience  has  proved 


430  OPEEATIONS    ON    THE    DIGESTIVE    APPARATUS. 

that  the  deeper  the  action  of  the  caustic,  the  more  successful  the 
operation  is  Hkely  to  be.  It  is  said  that  nearly  one  ounce  of  the 
acid  is  required  for  a  tumor  as  large  as  a  man's  fist,  and  that  the 
friction  should  be  continued  from  three  to  five  minutes.  The 
duration  of  the  friction  and  the  quantity  of  the  acid  to  be  used 
must,  however,  be  guaged  by  the  dimensions  of  the  tumor,  and 
also  with  careful  consideration  of  the  thickness  of  the  skin.  Dayot, 
to  whom  is  due  the  positive  and  i^ractical  introduction  of  this  mode 
of  treatment,  proposes  to  apply  the  acid  in  instalments,  and  recom- 
mends that  the  apphcation  be  repeated  once  or  twice  an  hour, 
according  to  the  thickness  of  the  skin,  .until  the  desired  effect  is 
assured.  The  result  of  our  own  experience  is  a  conviction  that  as 
a  rule  only  a  single  apphcation  is  necessary.  Nitric  cauterization 
produces  a  yellow  eschar,  which  ordinarily  remains  for  a  long  time, 
soft,  supple,  and  unctuous  to  the  touch,  but  the  epidermis  of  which 
is  easily  lacerated.  In  some  cases  the  formation  of  the  eschar  is 
followed  by  a  large  swelling  of  the  cauterized  parts  and  the  sur- 
rounding tissues.  Sometimes  it  makes  its  appearance  immediately 
following  the  operation,  but  more  commonly  it  appears  at  a  later 
period,  gradually  increasing  during  the  first  hours  following  the 
cautery,  although  again,  in  other  cases,  this  swelling  is  altogether 
absent.  The  oedema  is  the  direct  effect  of  the  action  of  the  caustic 
upon  the  subcutaneous  cellular  tissue,  which  becomes  infiltrated ; 
and  in  this  condition  apphes  a  uniform  pressure  in  all  directions 
upon  the  peritoneal  hernial  sac,  crowding  back  into  the  abdominal 
cavity  the  displaced  intestines  and  preventing  their  return  by  the 
kind  of  retentive  bandage  which  is  formed  by  the  engorgement 
which  takes  place  around  the  sac. 

In  the  days  following,  after  reaching  the  maximum  develojD- 
ment,  the  oedema  gradually  diminishes  by  resorption,  becoming 
at  the  same  time  somewhat  harder,  the  portions  of  cauterized  skin 
which  is  in  its  center  meanwhile  gradually  drying,  and  becoming 
transformed  into  a  dry,  hard  plate. 

In  place  of  the  hernia  there  now  remains  a  fibrous  mass  of  new 
formation,  which  gradually  diminishes  and  is  soon  more  or  less 
resorbed.  In  the  meantime,  while  these  phenomena  are  taking 
place,  the  process  of  the  separation  of  the  eschar  has  begun  and 
progressed,  and  on  the  eighth  day,  on  the  boundary  between  the 
dead  and  the  living  structures,  a  fissui'e  shows  itself,  and  minute 
granulations  appear.     The  sej)aration  goes  on  slowly,  from  the 


HEKNIA.  431 

circumference  to  the  center,  leaving,  when  complete,  a  rose  surface, 
granulating  evenlj^,  small  fibrous  formations  sometimes  appearing 
in  its  center.  This  wound  heals  rapidly,  leaving  a  contracted 
cicatrix,  which  assists  in  keeping  the  hernia  in  its  place,  while  the 
indurated  skin,  which  for  some  time  remains  adherent  to  the  stni 
fibrous,  abdominal,  subcutaneous  tissue,  contributes  to  the  com- 
plete obhteration  of  the  ring.  After  a  month  the  cure  is  radical, 
and  in  place  of  the  hernia,  there  remains  only  a  hairless  cicatrix, 
often  without  pigment. 

Though  this  treatment  is  simple,  and  has,  by  the  results  it  has 
shown,  justified  the  credit  it  enjoys  among  those  who  have  had 
experience  and  knowledge  of  its  working,  it  must  not  be  at  once 
accepted  as  infaUible,  or  unattended  with  danger.  Cases  are  on 
record  which  negative  such  a  claim.  For  instance,  too  sevei^e  a 
cauterization  may  be  followed  by  the  entire  sloughing  of  some 
portion  of  the  abdominal  walls,  followed  by  a  large  eventration ; 
and  peritonitis,  tetanus  and  intestinal  fistulse  are  comphcations 
which  have  sometimes  disappointed  hopes  which  seemed  to  be 
well  founded. 

Animals  to  which  this  treatment  has  been  applied  must  be 
carefully  watched  for  some  time  during  the  period  following  the 
cauterization.  They  must  be  especially  prevented  from  indulging 
the  tendency  they  often  betray — to  bite,  or  scratch  with  their 
feet  or  legs,  the  irritated,  cauterized  siirface.  A  cradle  or  aprons 
hanging  in  front  of  their  hind  legs,  or  even  bandages  may  prove 
effectual  to  prevent  this  suicidal  habit. 

The  topical  remedies  we  have  mentioned  before,  might  in 
strictness  be  considered  as  coming  under  the  head  of  external 
treatment,  since  they  have  all  been  applied  to  the  surface  of  the 
skin.  There  is,  howevor  another  mode  of  application  which  is 
subcutaneous,  and  which  is  represented  by  the  method  of  Dr. 
Luton,  and  employed  in  the  treatment  of  the  same  ailment  in 
children.  It  consists  in  injecting  subcutaneously,  at  each  cardinal 
points  of  the  hernial  sac,  a  few  di'ops  of  a  saturated  solution  of 
chlorides  of  sodium  (kitchen  salt).  We  have  had  but  one  oppor- 
tunity to  try  the  value  of  this  treatment,  which  we  improved  by 
injecting  ten  drops  of  this  solution  at  each  point  of  a  hernial 
tumor.  We  produced  an  enormous  swelling,  followed  after  several 
weeks  by  resorption  and  complete  disappearance  of  the  hernia. 
According  to  Peuch  and  Toussaint,  our  friend  M.    Cagny  has 


432  OPERATIONS    ON    THE    DIGESTIVE    APPARATUS. 

made  the  same  experiment,  but  failed  to  obtain  a  successful 
result. 

3d.  Surgical  Operations  for  the  Constriction  of  the  Tumor. — 
Modes  of  surgical  treatment  are  numerous,  usually  having  in  view 
the  destruction  of  the  hernial  sac,  by  the  process  of  mortification, 
so  controlled  and  directed  as  to  bring  about  the  necessary  work 
of  adhesion  between  the  walls  of  the  sac,  above  the  line  where  the 
mortification  begins,  with  the  formation  of  a  secondary  cicatriza- 
tion between  the  edges  of  the  skin,  where  the  mortified  sac  has 
dropped  off. 

Before  casting  the  animal,  without  which  the  operation  cannot 
be  performed,  the  surgeon  must  satisfy  himself  that  the  hernia  is 
reducible,  and  that  there  is  no  adhesion,  and  should  carefully 
measure  the  dimensions  of  the  sac  in  order  to  know  accurately 
where  the  constriction  must  be  applied.  The  animal  must  be 
placed  weU  on  his  back,  with  his  hind  quarters  elevated — a  posi- 
tion which  is  sometimes  sufficient  alone  to  enable  the  hernia  to 
reduce  itself.  If  that  fails  to  occm-,  the  sac  can  be  evacuated  by 
the  taxis.  It  is  then  to  be  well  stretched,  and  the  application  of 
the  means  of  constriction  proceeded  with. 

These  means  are  many,  but  may  be  considered  under  the  three 
heads  of  the  ligature,  the  clamp  and  the  suture — all  of  which  are 
occasionally  combined  in  use,  as  the  ligature  with  the  suture,  or 
the  suture  with  the  clamp. 

(«)  The  Ligature. — This  old  mode  of  operation  consists  in 
the  appHcation — the  hernia  having  been  reduced — of  a  strong 
cord,  firmly  tied  at  the  base  of  the  hernial  pouch. 

The  modus  operandi  is  very  simple.  The  hernia  being  already 
reduced,  either  by  the  taxis  or  by  the  power  of  gravitation,  as 
before  mentioned,  and  the  horse  in  the  right  position,  on  his  back, 
the  sac  is  raised  from  the  abdomen,  and  a  strong  Hgature,  firmly 
tightened,  is  appHed  at  its  base,  a  strong  fishing  line  forming  the 
best  of  ligature  for  this  purpose.  The  degree  of  tightness  of  the 
ligature  must  be  such  that  the  mortification  of  the  sac  will  be  a 
gradual  process,  and  that  it  does  not  slip  from  the  waUs  of  the 
sac,  on  account  of  the  progress  of  the  inflammatory  swelling. 
Still  this  constriction  must  not  be  permitted  to  become  so  ex- 
treme as  to  produce  too  rapid  a  sloughing  of  the  skin,  with  the 
possible  result  of  a  calamitous  eventration. 

In  order  to  prevent  the  displacement  of  the  ligature,  some 


HERNIA.  ^'^3 

practitioners  recommend  the  introduction  of  two  small  wooden 
pins  just  under  it,  either  parallel  or  crossing  each  other,  through 
the  base  of  the  sac. 

If  the  hernia  is  very  large,  instead  of  employing  tliis  mode  of 
simple  Hgature,  en  masse,  the  operator  may  use  two  ligatures. 
By  pushing  through  the  middle  of  the  sac,  close  to  the  abdomen, 
a  dog  seton-needle,  carrying  a  doubled  cord,  and  converting  it 
into  two  parts  in  cutting  it  from  the  needle,  each  length  will  serve 
to  embrace  half  of  the  tumor,  in  the  manner  practiced  in  the  pro- 
cess of  removing  large,  hard  tumors  by  ligature.  Legoff  has  rec- 
ommended the  use  of  several  ligatures  dipped  into  ammonia,  placed 
one  above  the  other  upon  the  whole  length  of  the  sac,  from  its 
bottom  to  its  base,  tightening  them  more  and  more  as  they  ap- 
proach the  abdomen.  By  this  process  he  combined  constriction 
with  cauterization. 

This  mode  of  treating  umbilical  hernia  is  a  simple  and  easy 
one,  but  yet  it  is  not  very  frequently  practiced.  The  uncertainty 
of  its  results,  the  possibility  of  the  sloughing  of  the  skin  at  too 
early  a  period,  with  the  danger  of  eventration,  as  well  as  that  of 
injuring  the  intestines  with  the  wooden  pins  or  the  needle,  have  all 
combined  to  impair  its  credit  and  discourage  its  use  among  care- 
ful operators. 

(b)  Clamp. — In  this  process,  which  dispenses  with  the  caustic, 
after  the  reduction  of  the  hernia,  the  skin  is  stretched  and  pressed 
between  the  branches  of  a  wooden  clamp  or  of  a  specially  adapted 
forceps.  The  clamp  is  a  simj)le  imj)lement,  and  may  be  made  with 
a  curve,  in  which  case  its  convexity  is  made  to  adapt  itself  to  that 
of  the  abdomen.  When  ax)phed,  it  is  pressed  close  to  the  abdom- 
inal walls,  and  its  branches  brought  together  with  nippers  adhoc, 
and  secured  with  a  strong  cord,  as  in  the  process  of  castration. 
The  clamp  is  left  on  from  nine  to  fifteen  days.  In  many  cases, 
the  displacement  of  the  instrument  is  prevented  by  using  the 
wooden  or  metaUic  pins  passed  through  the  skin  below  it,  the 
ends  of  the  latter  being  bent  over  to  keep  them  in  place.  This 
operation  possesses  some  great  advantages,  but  ofi^ers  also  some 
special  dangers,  among  which  is  the  instinctive  tendency  of  the 
patient  to  get  rid  of  the  irritating  appliance  by  tearing  it  ofif. 

Another  objection  to  the  clamp  is  found  in  the  danger  of  caus- 
ing troublesome  excoriations  of  the  sheath  by  the  friction  which 
it  necessarily  occasions.     Benkert  and  Brogniez  have  advocated 


434  OPEKATIONS    ON    THE    DIGESTIVE    APPARATUS. 

the  use  of  metallic  clamps,  but  an  important  objection  is  found  in 
their  weight.  Borhauer  had  the  branches  of  the  wooden  clamp 
perforated  in  several  places  for  the  introduction  of  the  pins  which 
held  it  in  place.  Bordonnat  has  invented  a  special  form  of  me- 
tallic clamp  or  rather  forceps,  with  sharp  points  on  the  inner  bor- 


PiG.  391.— Clamp  of  Bordonnat. 

der  of  one  of  its  branches  about  one-half  or  three-quarters  of  an 
inch  ajjart,  and  in  the  other  a  corresj^onding  number  of  holes  into 
which  the  points  are  designed  to  fit  when  the  instrument  is  closed. 
Each  branch  has  a  prolongation  at  each  end,  which  on  one  carries 
a  vertical  projection  cut  with  a  screw-thread,  while  in  the  other 
there  are  holes  corresponding  with  the  projections,  and  there  are 
nuts  to  fit  the  screws.  "When  the  instrument  is  appHed,  and  the 
projections  passed  through  the  holes,  the  nuts  not  only  hold  it 
in  place,  but  are  adapted  to  fix  the  pressure  at  any  desired  point, 
or  change  it  at  pleasure.  The  umbilical  forcej)s  of  Marlot  is 
made  of  two  small  wooden  plates,  slightly  curved  lengthwise,  and 
brought  together  by  means  of  gooves  in  their  dove-tailed  extremi- 
ties, through  which  screws  are  fastened.  This  instrviment,  like 
the  metallic  clamps,  is  objectionable  principally  on  account  of 
its  weight,  and  is  generally  less  practical  than  the  ordinary  clamp. 

(c)  Sutures. — These  are  of  various  kinds,  all  agreeing,  how- 
ever, that  the  stitches  upon  which  they  rely  shall  be  so  close  and 
tight  that  the  circulation  will  be  so  efi'ectually  cut  off  in  every 
part  of  the  hernial  sac  that  mortification  cannot  fail  to  follow. 

The  Quilled  Suture. — This  consists  in  placing  the  sac  between 
two  small  rods  of  hard  wood  or  metal,  and  tying  them  before  and 
behind  with  strong  cord  twisted  and  rolled  around  their  extremi- 
ties, and  also  by  passing  here  and  there  in  their  length  sutures  of 
double  the  strength  of  those  which  are  appHed  in  cases  of  ordi- 
nary quilled  suture.  Acting  somewhat  by  pressure,  this  mode 
much  resembles  the  treatment  by  the  clamp,  but  is  httle  used  at 
present,  notwithstanding  some  small  advantages  which  it  may  be 
thought  to  possess. 


HEENIA.  435 

Twisted  ^Sutures. — This  consists  in  applying  upon  the  hernial 
sac  several  stitches  of  strong  cord  in  order  to  keep  the  reduced 
hernia  in  statu  quo.  It  is  sometimes  used  in  dogs,  but  is  uncer- 
tain and  dangerous. 

Suture  of  Delavigne.  —  This  is  another  dangerous  mode  of 
operation,  no  longer  in  practice  because  of  the  hazard  of  injury  to 
the  intestines.  It  consists  in  ai^plying  a  strong  double  suture  at 
the  base  of  the  sac  in  the  following  manner :  With  a  small  needle, 
like  that  used  by  harness  makers  in  sewing  leather,  a  thread  is 
I^assed  through  and  through  on  both  sides  of  the  flat,  cutaneous 
surface  from  right  to  left,  or  vice  versa,  then  carried  back  the  re- 
verse way  at  a  small  distance  from  the  first  puncture,  and  the 
sutures  firmly  tied.  This  is  repeated  until  the  entire  sac  is  in- 
cluded and  the  sutures  have  gone  beyond  the  umbilicus.  From 
fifteen  to  twenty  days  are  said  to  be  sufficient  to  effect  a  radical 
cure. 

Method  of  Mangot. — To  make  a  closing  suture  on  the  hernial 
sac,  without  danger  to  the  intestine,  Mangot  has  recommended 
the  use  of  a  perforated  plate  of  lead,  by  which  to  aid  in  the  reten- 
tion of  the  intestines  in  place  and  accurately  define  the  line  ujJon 
which  the  sutures  are  to  be  applied.  The  plate  is  made  to  cor- 
respond in  dimensions  with  the  opening  of  the  umbilical  ring,  but 
somewhat  longer  and  wider.  Besides  the  longitudinal  slit  in  its 
center,  it  also  has  an  eye  at  each  corner  for  the  attachment  of 
strings  to  secure  it  in  place  by  tying  them  over  the  back.  The 
hernia  being  reduced,  and  the  plate  put  in  place  by  pushing  the 
skin  of  the  sac  through  its  longitudinal  opening,  the  operator  ap- 
phes  a  continued  suture  over  and  on  the  outside  of  the  plate  to 
keep  it  in  position,  with  the  flap  of  sewed  skin  hanging  below  it, 
the  entire  apparatus  being  securely  attached  to  the  abdominal 
walls  by  two  pins  running  through  the  sac  at  the  extremities  of 
the  suture. 

During  the  first  days  there  is  much  inflammation.  About  the 
third  or  fifth  day  the  pins  are  removed  and  the  skin  below  the  su- 
ture excised,  leaving  the  plate  to  be  retained  only  by  the  strings 
which  pass  over  the  back.  These  are  sufficient,  however,  to  keep 
it  in  place,  and  its  removal  will  not  be  necessary  until  inflamma- 
tion is  well  estabUshed  all  around  them.  A  simple  dressing,  held 
in  place  by  a  bandage,  will  help  the  cicatrization,  which  is  said  to 
take  place  in  from  seven  to  eight  days. 


43G 


OPERATIONS    ON    THE    DIGESTIVE    APPARATUS. 


Method  of  Hannon. — The  modus 
operandi  here  indicated  does  not  vary 
from  that  of  Mangot,  except  in  being 
modified  by  the  use  of  the  quilled  su- 
ture, as  before  described,  instead  of 
employing  the  transversal  pins  of  Man- 
got. 

Method  of  Mignon. — This  is  a  com- 
plex mode,  consisting  of  a  combination 
of  the  ligature,  the  clamp  and  the  sutiu'e. 
Like  Mangot,  he  passes  the  skin  through 
a  plate  of  lead,  attaches  perforated  clamps 
on  the  fjrotruding  sac  below  it,  and  pass- 
es the  stitches  or  sutures  through  the 
jDerforations  in  the  clamps. 

Method  of  Benard. — This  is  strictly 
speaking,  the  application  of  the  crossed 
suture,  a  stitch  exactly  resembling  that 
of  harness  and  shoemakers  in  their  re- 
spective trades.  In  making  it,  a  pecuhar 
forceps  is  used,  which  is  appHed  like  a 
clamp,  and  serves  not  only  to  keep  the 
sac  closed  and  secured,  but  also  to  pre- 
vent the  return  of  the  intestines  into  its 
cavity,  and  to  assist  in  guiding  the  two 
needles  with  which  the  suture  is  made. 
Its  branches  are  at  one  end  articulated 
together,  and  also  at  the  other  in  order 
to  fit  into  handles.  It  is  twenty-two  cen- 
timeters in  length,  without  including  the 
handles ;  two  centimeters  in  height,  and 
one  and  a  half  in  thickness.  The  branch- 
es are  brought  together  tightly  by  a  spe- 
cial screw  arrangement  near  the  handles, 
and  each  has  a  number  of  holes,  placed 
regularly,  one  centimeter  apart,  and  uni- 
ted by  a  groove.  Two  sti-ong  straight 
needles  and  strong  waxed  thread  are  re- 
quired. In  operating,  the  hernia  being 
first  reduced,  the  skin  is  well  stretched  fig.  392.- 


0 


0 


-Nippers  of  Benard. 


437 


between  the  branches  of  the  forceps,  then  these  are  tightened  by 
the  screw  management  of  the  handles,  and  next  the  instrument 
is  committed  to  the  care  of  an  assistant.  The  crossed  suture  is 
then  made  by  the  simultaneous  passage  of  the  needles  through 
the  holes  in  the  branches  of  the  instrument.  The  directions  to 
insert  the  needles  simultaneously  must  not  be  overlooked.  If 
disregarded,  the  penalty  liable  to  follow  will  be  the  tearing  of  the 
waxed  thread  with  the  points  of  the  instrument,  and  also  a  tang- 
ling of  the  thread.  This  method  gives  a  stronger  ligature  than 
Mangot's,  but  it  lacks  the  support  furnished  by  the  metallic  plate. 
Method  of  Marlot. — The  methods  of  Benard  and  Mangot  are 
here  combined.  A  pecuHar  thin  forceps  is  used  having  dotted 
grooves  on  its  outer  surface  to  indicate  where  the  stitches  are  to 


Fig.  393.— Plate  and  Nippers  of  Marlow. 

be  placed.  When  the  suture  is  finished  and  the  forceps  removed 
a  plate  of  zinc  like  that  of  Mangot  is  appUed,  as  a  means  of  reten- 
tion, the  zinc  plate  being  thought  to  be  an  improvement  upon  that 
of  lead,  on  account  of  its  ad^-pting  itself  better  to  the  parts. 

Method  of  Chedhomme. — The  animal  in  this  method  is  kept  on 
his  feet,  properly  secured,  and  a  plate  of  lead  applied,  as  in  the 
process  of  Mangot.  The  hernial  sac,  folded  in  two  on  its  longitu- 
dinal axis  is  then  passed  through  the  opening  of  the  plate,  the 
operator  making  the  least  possible  traction  until  the  remaining  por- 
tion of  the  umbihcal  cord,  which  is  still  quite  large,  is  firmly  held 
between  the  thumb  and  the  index  finger  of  the  right  hand.  Then 
a  stronger  traction  is  made  upon  the  sac,  at  the  same  time  moving 
it  in  various  directions,  while  with  the  left  hand  the  plate  is 
strongly  pressed  towards  the  abdominal  walls.  Then  with  the 
intestines  entirely  replaced,  the  operator  grasps  the  sac  with  the 


438  OPERATIONS    ON    THE    DIGESTIVE    APPARATUS. 

left  hand,  and  with  the  right,  introduces  a  strong  needle  which  is 
pushed  through  and  through  at  each  extremity  of  the  sac,  and 
an  elastic  hgature  passed  three  or  four  times  aroiind  its  base. 
Towards  the  tenth  day  the  slough  is  completed,  and  only  a  small 
wound  remains,  which  cicatrizes  rapidly. 

Direct  Suture  of  the  umbilical  ring. — Director  Degive  recom- 
mends for  the  treatment  of  umbilical  hernia  in  young  dogs,  the 
direct  interrupted  sutures  of  the  ring,  the  number  of  stitches 
varying  with  its  dimensions.  After  bringing  the  threads  together 
the  wound  is  left  open  until  they  have  safely  eliminated  themselves. 
We  have  employed  this  mode  of  operation  for  many  years  in  the 
hospital  of  the  American  Veterinary  College,  using  antiseptic  pre- 
cautions, and  with  the  best  results.  Making  a  longitudinal  line 
on  the  median  Hne  of  the  sac,  and  having  carefully  pushed  back 
the  intestines,  the  edges  of  the  ring  are  sewed  together  with  two 
or  three  stitches  of  cat  gut  ligature.  The  parts  were  then  thor- 
oughly washed  with  a  solution  of  bichloride  of  mercury,  and  the 
edges  of  the  skin  brought  together  with  silk  sutures  and  a  com- 
pressing bandage  appHed  for  the  protection  of  the  wound  from  the 
patient's  own  teeth.     Complete  cicatrization  follows  in  a  few  days. 

Whatever  may  be  the  original  mode  of  treatment  the  secondary 
effects  are  about  the  same  in  each  case.  They  consist  of  ii'ritation 
of  the  parts,  more  or  less  marked,  and  betrayed  by  the  patients  by 
varying  degrees  of  restlessness,  and  possibly,  in  some  cases,  by 
abdominal  pain  or  cohcs. 

After  a  few  hours  the  swelling  of  the  j)art  begins.  A  diffused 
oedema  takes  place  above  the  point  of  comj)ression,  and  the  hernial 
sac  is  shghtly  swollen  and  warm  and  becomes  covered  with  little 
phlyctenoids,  indicating  a  commencing  necrosis.  Perhaps  a  little 
fever  is  manifested  and  there  is  great  thirst.  By  the  third  day 
the  swelling  is  quite  large,  and  in  males  it  may  involve  the  sheath. 
The  sac  then  becomes  cooler,  the  fever  subsides,  the  appetite  re- 
turns, and  the  animal  which  has  instinctively  kept  his  feet,  rests 
himself  by  lying  down.  On  the  fourth  or  fifth  day  the  skin  of  the 
sac  is  insensible,  cold  and  flabby,  and  the  sloughing  process  between 
the  Hving  and  the  dead  skin  has  begun.  Little  by  little  this  pro- 
cess becomes  more  active,  and  the  separation  becomes  more  and 
more  marked,  the  secretion  around  its  opening  a  purulent  character, 
and  from  the  sixth  to  the  tenth  day  the  complete  sloughing  will 
have  taken  place.     The  wound  that  remains  is  now  granulating. 


HEKNIA.  439 

Its  lengtli  exceeds  its  widtli,  and  it  is  somewhat  depressed  in  its 
center  It  progresses  rapidly  towards  cicatrization,  only  a  small 
scar  remaining,  and  this  is  readily  concealed  by  the  growth  of  the 
surrounding  hair. 

{d)  Operation  in  Cases  of  Complications. — If  the  hernia  is 
irreducible  and  there  is  strangulation,  the  enlargement  of  the  ring 
must  be  carefully  made  with  a  curved,  blunt  bistoury,  having  a 
short,  guarded  sharp  edge.  When  the  reduction  is  prevented  by 
adhesions,  the  operation  necessary  for  their  division  will  demand 
the  exercise  of  the  utmost  skill  and  caution  to  avoid  injury  of  the 
peritoneum,  and  there  should  especially  be  no  neglect  or  parsi- 
mony in  respect  to  the  employment  of  antiseptic  precautions.  In 
fact,  it  would  in  many  instances  be  wiser  to  leave  the  animal  to 
the  resources  of  nature  than  to  undertake  an  operation  of  so  much 
dehcacy  and  importance,  and  which  involves  so  many  serious  con- 
sequences, without  amj)ly  providing  every  resource  of  skill  and 
knowledge,  and  anticipating  every  contingency  of  accident  or  dan- 
ger. In  some  cases,  when  the  strangulation  has  been  due  to  the 
formation  of  gases  in  the  protruding  intestine,  we  have  used  the 
aspirator  for  theii"  removal,  and  then  have  met  with  no  difficulty 
in  reducing  them  by  the  taxis.  This  is  a  means,  however,  which 
is  also  recommended  in  the  treatment  of  strangulated  inguinal 
hernia,  and  is  discussed  in  the  chapter  appropriated  to  operations 
in  that  region. 

Diaphragmatic   Hernia. 

A  diaphragmatic  hernia,  or  diaphragmatocele,  is  formed  by  the 
displacement  of  one  of  the  abdominal  organs,  and  its  intrusion 
into  the  pleural  cavities,  through  a  laceration  of  the  diaphragm.  It 
is  necessarily  an  accidental  opening,  through  which  such  a  dis- 
placement takes  place.  One  case  is  on  record,  and  only  one, 
where  the  hernia  passed  through  a  normal  opening,  viz.,  the  oeso- 
phageal. 

The  causes  which  give  rise  to  ruptures  of  this  kind  may  be 
classilied  under  three  heads :  first,  external  violence ;  second,  pow- 
erful contraction  of  the  expiratory  muscles  while  making  a  violent 
effort ;  and  third,  the  exertion  of  force  and  pressure  upon  the  dia- 
phragm by  the  organs,  situated  on  its  posterior  face. 

{a)  External  Violence. — Foremost  in  this  category  are  blows 
or  contusions  on  the  posterior  costal  region,  such  as  may  be  made 


440  OPERATIONS    ON    THE    DIGESTIVE    APPAEATUS. 

by  the  shafts  of  vehicles  with  either  the  blunt  or  broken  ends. 
The  laceration  of  the  diaphragm  may  occur  either  with  or  without 
involving  the  fracture  of  the  ribs.  Several  cases  of  this  kind  have 
been  seen  and  recorded  by  Professor  Barrier. 

(b)  The  Powerful  Contractions  of  the  Expiratory  Muscles 
during  Yiolent  Muscular  Efforts. — It  may  result  from  the  vio- 
lent and  concentrated  action  of  the  abdominal  muscles,  compress- 
ing powerfully  the  intestinal  mass,  and  crowding  it  against  the 
diaphi-agm,  until  it  destroys  its  continuity  at  one  or  more  points, 
sufficiently  to  admit  of  the  passage  of  the  abdominal  organ  into 
the  thoracic  cavity.  Durand  has  seen  it  in  a  six-months-old  colt ; 
Didry  and  Fabey  have  reported  cases  where  the  hernia  took  place 
during  violent  efforts  in  hauling  a  load,  and  Franconi  met  with  a 
case  of  a  similar  character  to  the  one  referred  to  in  which  the  rup- 
ture opened  into  the  oesophagus.  Schild  has  seen  it  associated 
with  the  efforts  of  parturition. 

(c)  Yiolent  Action  and  Pressure  upon  the  Diaphragm  by  the 
Organs  Situated  on  its  Posterior  Face. — The  obliquity,  forward 
and  downward,  of  the  inferior  plane  of  the  abdomen,  is  shared 
forward  upon  the  posterior  face  of  the  diaphragm  by  the  organs 
related  to  it,  as  the  Hver,  the  stomach  and  the  anterior  cm^vatures 
of  the  large  colon.  These  are  bulky  organs,  and  their  united 
weight  being  very  considerable,  the  pressure  it  exerts  upon  the 
diaphragm,  under  any  extra  impulse  would  tend  directly  and  nat- 
urally to  the  disruption  of  the  weaker  muscular  fibres  of  the 
midriff,  and  these  yielding,  the  hernia  would  immediately  become 
developed,  and  thus  we  have  the  generation  of  this  kind  of  hernia. 
A  sudden  fall  might  easily  bring  this  to  pass,  in  a  second  or  two 
of  time.  Bouley  has  recorded  a  case  in  which  this  accident  oc- 
cured  in  an  animal  cast  for  a  surgical  operation.  Pilton  has  seen 
it  take  place  in  an  animal  falling  down  while  butting  against  a 
slope  of  ground. 

Diaphragmatic  hernias,  like  others,  are  either  acute  or  chronic ; 
or  convertibly,  recent  and  free,  or  of  old  standing,  with  adhesions. 
The  distinctions  of  hepatocele,  splenocele,  stomachocele  and  entero- 
cele  are  of  but  Httle  importance,  none  of  these  differences  being 
discoverable  in  the  living  animal. 

The  symptoms  of  acute  hernia  of  the  diaphragm  differ,  accord- 
ing to  the  extent  of  the  laceration  of  the  muscle,  and  the  size  of 
the  displaced  abdominal  mass.     There  are  cases  in  which  the  in- 


HERNIA.  441 

jury  is  of  so  aggravated  a  character  from  the  first,  that  a  fatal 
result  immediately  follows  the  formation  of  the  hernia,  the  only 
characteristic  symptoms  present  being  those  of  rajjid  asphyxia. 
In  other  cases,  though  death  must  ine\'itably  follow,  the  hfe  of 
the  animal  may  be  prolonged  for  several  hours,  or  even  several 
days.  And  again,  there  are  recent  hernias  which  have  been  formed 
under  such  conditions  that  they  are  still  compatible  with  the  sur- 
vival of  the  animal.  These  assume  the  chronic  character,  and  not 
infrequently  escape  discovery. 

The  horse  affected  with  diaphragmatic  hernia  becomes  dull, 
anxious  and  uneasy,  avoiding  his  manger  and  avoiding  his  food. 
He  paws  in  the  stall,  giving  evidence  of  suffering  from  abdominal 
pains,  but  which  betray  no  pecuhar  characteristics,  and  possess 
no  special  or  positive  significance.  Very  often  cohcs  precede 
the  hernia,  and  its  formation  complicating  the  case,  the  colics  be- 
come more  violent.  During  these  colics  the  animal  hesitatingly 
and  carefully  lies  down,  rolls  much,  and  assumes  various  attitudes 
of  no  special  significance,  though  the  dog-sitting  posture  is  some- 
times held  to  be  characteristic.  During  these  colics,  which  are 
more  persistent  than  those  due  to  intestinal  indigestion,  the  pulse 
remain  strong  and  quite  regular,  and  respiration  is  not  only  ac- 
celerated, but  difficult — the  physiognomy  is  anxious,  with  an  ex- 
pression of  apprehended  suffocation,  the  nostrils  are  tetanically 
dilated,  inspiratory  movements  are  performed  with  effort,  and 
expiration  is  of  twice  or  three  times  its  normal  frequency.  The 
coexistence  of  this  condition  of  the  respiration  with  the  colics  is 
a  sign  of  great  importance  as  an  element  of  the  diagnosis.  At 
times  auscultation  furnishes  valuable  data.  Borborygmus  may  be 
detected  in  the  thorax,  where  the  respiratoiy  murmur  ought  to 
be  heard,  and  dullness  on  percussion  takes  the  place  of  the  nor- 
mal resonance,  where  the  respiratory  murmur  has  disappeared. 

Bouley,  though  he  recommends  this  means  of  diagnosticating, 
considers  it  to  be  applicable  only  for  hernias  of  large  size,  in  which, 
according  to  Lafosse,  an  increase  in  the  size  of  the  thorax,  a  well 
marked  projection  of  the  cartilaginous  circle  of  the  ribs,  and  to- 
gether with  these,  a  reduction  in  the  size  of  the  abdomen  would  be 
noticed.  When  the  hernia  is  small,  the  respiratory  function  is 
unaltered. 

Acute  diaphragmatic  hernias,  not  necessarily  of  fatal  tendency, 
are  more  difficult  to  detect.     Probably  from  their  rareness  they 


442  OPERATIONS    ON    THE    DIGESTIVE    APPARATUS. 

often  escape  discovery,  notTvithstanding  a  somewhat  positive  exhi- 
bition of  abdominal  and  thoracic  symptoms.  And  if  this  is  so 
with  the  acute  form,  it  must  necessarily  more  frequently  occur  with 
chronic  cases,  which  not  only  do  not  jeopardise  Hfe,  but  even  fail 
to  interfere  with  the  usefulness  of  the  animal.  The  horse  thus 
affected  not  only  has  the  double  expiration  of  his  emphysematous 
lungs,  but  he  continues  to  be  subject  to  intermittent  coHcs,  and 
especially  if  the  hernia  is  formed  by  the  intestines,  and  they  con- 
tinue to  suffer  from  occasional  obstructions.  To  this  compUcation 
of  occasional  actual  obstruction  must  be  added  a  perpetual  Hability 
to  become  strangulated,  with  a  certainty  of  speedy  death  following 
that  accident. 

The  lesions  found  at  the  post-mortem  examinations  of  ani- 
mals which  have  died  with  this  description  of  hernia  varies.  The 
accidental  diaphragmatic  openings  may  exist  in  different  parts 
of  the  central  aponeurotic  portion  or  in  the  perij^herical  muscular 
zone,  and  may  assume  various  forms,  being  at  one  time  round,  at 
another  ehptic  or  triangular,  or  indefinite  and  irregular,  at  times 
very  narrow,  at  others  so  extensive  that  the  abdominal  and  thoracic 
cavities  are  no  longer  distinct.  Between  these  two  extremes  there 
are  many  degrees  and  ample  scope  for  the  formation  of  chronic 
hernias  of  a  non-malignant  character.  When  the  hernia  is  recent 
and  has  existed  before  death,  the  borders  of  the  laceration  whether 
muscular  or  aponeurotic,  are  irregular,  thready,  infiltrated  and 
bloody,  with  small  blackish  clots  adhering  to  the  extremities  of 
the  red  muscular  fibres.  But  when  the  rupture  is  of  post-mortem 
formation,  resulting  from  excessive  meteorism,  there  is  no  trace  of 
capUlary  hemorrhage  upon  the  lacerated  edges  of  the  aperture. 

With  a  chronic  hernia  these  edges  have  various  aspects;  at 
times  thin,  at  others  in  thick  cords ;  now  torn  in  scallops,  and 
again  with  a  regular  edge,  they  are  always  smooth,  hard,  of  fibrous 
consistency,  and  even  presenting  a  cartilaginous  aspect.  There  is 
never  any  formation  of  a  special  serous  sac  for  these  hernias,  even 
for  those  which  take  place  through  the  normal  openings.  The 
organs  most  commonly  met  in  these  diaphragmatoceles  are  the 
omentum,  the  small  intestines,  the  anterior  curvature  of  the  large 
colon,  and  more  rarely,  the  spleen  and  the  stomach.  If  not  con- 
gested by  jii-essure  in  passing  through  the  opening,  they  continue 
to  perform  their  functions. 

In  these  injui'ies  the  prognosis  can  never  be  confidently  favor- 


HERNIA.  443 

able.  It  is  always  serious.  Some  kill  immediately,  while  with 
others  there  may  be  a  resj)ite  of  several  hours  or  days,  and  with 
those  which  are  chronic,  there  may  be  no  apparent  impairment  of 
life  or  health.  But  whatever  may  be  the  character  or  the  aspect 
of  a  given  case,  and  however  the  prognosis  may  vary,  it  must 
never  be  forgotten  that  diajjhragmatic  hernia  has  this  invariable 
character,  that  its  effect  is  always  to  interfere  with  the  respiration ; 
that  the  horse  is  at  the  best  permanently  afifected  with  heaves,  is 
unable  to  perform  any  active  or  laborious  service  where  strong 
lungs  are  needed,  and  is  always  more  or  less  Hable  to  engorgement 
and  strangulation.  Diaphragmatic  hernias  are  incurable,  their  sit- 
uation, in  the  deepest  interior  of  the  anatomy,  rendering  it  impos- 
sible to  api^ly  any  means  of  direct  therapeutic  treatment.  They 
cannot  be  reduced,  and  even  if  that  were  practicable,  they  could 
not  be  secured  and  retained  ^V^  situ.  Attempts  have  been  recom- 
mended by  Bouley  to  reduce  them  by  making  an  incision  through 
the  flank  and  replacing  the  protruding  organ  in  its  projDer  posi- 
tion by  the  taxis  with  the  hand  in  the  abdominal  cavity.  Whether 
in  our  days  of  perfect  antiseptics  such  an  operation  could  be  suc- 
cessfully performed  on  the  horse  is  a  question  not  yet  solved.  The 
experiment  might  be  attempted  with  better  chances  of  success  in 
cattle.  In  any  case  the  operation  will  be  justifiable  only  as  a 
last  resource,  and  when  the  life  of  the  suffering  animal  is  abso- 
lutely in  jeopardy,  in  fact,  as  a  final  alternative,  a  dernier  resort. 

Ventral  Hernia. 

This  term  includes  all  hernial  tumors  produced  by  the  pro- 
trusion of  one  or  several  of  the  abdominal  organs  through  an  ac- 
cidental opening  in  the  muscular  and  fibrous  walls  of  the  abdomen, 
under  the  skin,  which  remains  intact.  The  opening  through  which 
this  kind  of  rupture  takes  place  is  always  accidental,  unlike  those 
which  pass  through  the  natural  channels,  as  the  umbilical  or  in- 
guinal, but  still,  in  common  with  them,  has  a  peritoneal  lining. 

Ventral  hernias  are  of  quite  common  occurrence,  principally 
however,  in  large  animals,  while  in  small  quadrupeds  they  occur 
less  frequently,  and  they  may  take  place  in  any  part  of  the  abdo- 
men. They  are  known  by  distinctive  names,  corresponding  with 
those  of  the  protruding  organ,  as  gastrocele,  hepatocele.,  enterocele 
and  epiploocele,  etc. 

They  usually  originate  as  direct  causes  in  blows  or  contusion 


444 


OPERATIONS    ON    THE    DIGESTIVE   APPAKATUS. 


^4= 


Fig.  394.— Vential  Utrn  a. 

upon  the  abdominal  walls,  made  by  blunt  bodies,  which,  lacking 
force  to  pierce  through  the  elastic  skin,  are  jet  sufficient  to  lace- 
rate the  interior  abdominal  walls.  An  example  of  this  occurs  in  a 
thrust  from  the  shaft  of  a  vehicle,  or  its  broken  end,  in  case  of 
a  faU,  or  of  kicks  or  horning  among  cattle  in  the  field.  In  colts 
they  are  more  commonly  found  in  the  lower  wall  of  the  abdomen, 
the  animal  frequently  inflicting  them  upon  itself  by  attempting  too 
high  a  jump  over  a  picket  fence,  and  failing  to  clear  it  properly. 
Serres  says  that  in  cattle  they  may  follow  a  severe  distension  of 
the  abdomen  under  the  influence  of  tympanitis,  abdominal  dropsy, 
or  gestation. 

The  character  of  a  case  of  ventral  hernia  wiU  vary  in  respect 
to  its  being  acute  and  recent,  or  chronic  and  old.  Indeed,  the 
lapse  of  but  a  few  hours  will  materially  change  its  character  from 
one  to  the  other.     If  seen  immediately  after  the  infliction  of  the 


HERNIA.  445 

injury,  it  is  in  the  form  of  a  round,  soft,  elastic  tumor,  well- 
defined  in  its  outlines,  and  easily  reducible.  But  if  not  examined 
until  after  a  season  of  delay,  the  definite  configuration  disappears, 
and  it  is  changed  into  an  inflammatory  swelHng,  oedematous,  warm 
and  painful  to  pressiire — in  fact  ha^dng  the  aspect  of  a  warm  ab- 
scess. In  the  recent  cases,  the  edges  of  the  torn  abdominal  walls 
may  be  identified  through  the  thickness  of  the  skin,  but  the  sur- 
geon will  vainly  try  to  make  out  this  condition  if  the  inflamma- 
tory process  following  the  lesion  has  become  established,  and  the 
serosity  and  the  blood  have  become  sufficiently  infiltrated  into  the 
cellular  tissue  to  make  the  change  described.  After  a  few  days, 
if  the  hernia  is  not  situated  too  low  in  the  abdomen,  the  swelling 
moves  downward  toward  a  more  dependent  spot,  and  gradually 
abating  disappears  in  about  two  weeks.  Upon  reaching  this 
point,  the  hernial  tumor  is  once  more  recognized,  constituting,  as 
it  does,  the  exclusive  manifestation  of  the  displacement  of  the  in- 
testinal mass,  and  its  presence  outside  of  its  natural  cavity.  It  is 
recognized  by  its  changing  conditions — elastic  when  the  intestine 
is  empty  ;  soft  and  pufiy  during  digestion ;  by  its  state  of  tension, 
increasing  with  effort,  and  by  being  painless,  depressible  and  re- 
ducible. "When  reduced,  the  edges  of  the  opening  are  easily 
made  out,  but  it  is  not  uncommonly  found,  upon  the  subsidence 
of  the  inflammatory  process,  that,  during  the  continuance  of  that 
state,  adhesions  of  the  protruding  organ  with  the  walls  of  the 
sac  have  formed,  and  the  hernia  has  become  irreducible.  In  their 
dimensions,  ventral  hernias  vary  considerably.  They  may  measure 
from  the  size  of  a  large  nut  to  that  of  a  man's  head,  or  even  exceed 
that.  Zundel  reports  a  case  where  the  rumen  had  penetrated  into 
the  sac,  which  hung  almost  to  the  ground,  and  had  produced  a  dis- 
placement of  the  mammse,  crowding  them  in  a  mass  toward  the 
right  side  of  the  abdomen. 

Although  the  diagnosis  of  ventral  hernia  is  not  difficult,  it  is 
still  not  impossible  to  mistake  a  recent  case  for  certain  other  affec- 
tions of  the  abdominal  walls,  such  as  tumors  of  bacterian  anthrax, 
or  those  of  a  bloody  nature,  or  with  phlegmonous  or  oedematous 
growths.  The  reducibility  and  elasticity  of  the  tumor,  the  bor- 
borygmus,  and  the  presence  of  the  opening  through  the  abdomi- 
nal walls,  are  intelhgible  signs  by  which  to  recognize  the  ventral 
hernia.  Aspiration  of  the  tumor  may  sometimes  be  performed, 
and  rectal  examination  will  also  be  of  great  assistance  provided 


446  OPERATIONS    ON    THE    DIGESTIVE    APPARATUS. 

the  injury  is  not  beyond  the  reach  of  exploration  with  the  hand. 

Certain  complications  are  not  uncommon  in  ventral  hernia. 
Besides  irreducihUity  already  mentioned,  excessive  infiammation 
has  sometimes  been  followed  by  traumatic  peritonitis.  Lacera- 
tions of  the  disj^laced  organs  have  proved  fatal.  Internal  hemor- 
rhages, fistulas  and  consecutive  eventration  have  also  been  record- 
ed. Strangulation  is  not  unknown,  though  it  is  comparatively 
rare. 

But  with  all  these  possibilities,  it  is  not  a  rare  circumstance  to 
meet  with  animals  affected  with  ventral  hernia,  even  of  large  di- 
mensions, which  have  reached  a  good  age  with  all  the  appearance 
of  perfect  health.  From  data  like  these  upon  which  to  found  a 
judgment,  it  ought  not  to  be  difficult  to  deduce  a  prognosis  which 
should  never  be  far  wrong.  But,  although  compatible  with  the 
life,  health  and  utilization  of  the  animal,  such  a  lesion  must  neces- 
sarily detract  more  or  less  from  its  commercial  value.  Under 
any  circumstances,  it  is  a  blemish.  The  least  dangerous  of  this 
class  of  ruptures  are  those  which  are  situated  on  an  elevated  point 
of  the  abdomen.  Recent  and  uncompHcated,  they  are  amenable 
to  treatment  more  or  less,  according  to  their  extent ;  if  old  or 
chronic,  the  chances  of  success  are  reduced  ;  if  strangulated,  they 
are  generally  fatal.  Usually,  a  ventral  hernia,  to  be  curable, 
must  be  treated  when  it  is  recent,  and  before  sufficient  time  has 
elapsed  for  the  intestines  to  become,  as  it  were,  accommodated  to 
their  new  position,  and  especially  before  the  cicatrization  of  the 
borders  of  the  lacerated  openings  has  taken  place.  Eecent  and 
free  from  compHcations,  all  that  is  required  is  their  reduction 
and  retention  in  their  proper  place. 

When  reduced,  whether  by  rectal  taxis  or  by  external  pres- 
sure, the  parts  are  covered  with  a  mixture  of  pitch  and  Venice 
turpentine  melted  together,  upon  which  is  spread  oakum  cut  in 
small,  short  threads,  which  is  to  be  covered  with  a  second  appli- 
cation of  the  j)itch,  after  which  a  sheet  of  pasteboard,  itself  also 
impregnated  with  the  pitch  mixture,  is  placed  over  the  oj^ening. 
The  whole  is  then  covered  and  held  in  place  by  a  broad  bandage 
carefully  roUed  around  the  abdomen.  Leather  is  sometimes  used 
in  Heu  of  the  pasteboard.  This  bandage,  when  applied  uj^on  male 
bovines,  requires  to  be  carefully  adapted  in  order  to  avoid  any 
possible  interference  with  the  penis,  and  its  freedom  of  motion  in 
the  act  of  micturition.     The  complications  of  swelling  or  bloody 


HEENIA.  447 

extravasations  must  not  prevent  the  immediate  application  of  the 
bandage. 

in  cases  of  chronic  hernia,  compression  is  no  longer  sufficient. 
Jannet  recommends  the  use  of  clamps  as  in  umbihcal  hernia,  and 
reports  having  reheved  a  case  vrhere  the  tumor  was  as  large  as  a 
child's  head.  Leblanc  advises  the  quilled  suture,  and  Schwane- 
feld  cm-ed  by  this  mode  a  hernia  twice  as  large  as  the  head  of  a 
man.  Hertwig  speaks  favorably  of  the  application  of  Delavigne's 
method  in  exomphalus.  Going,  Lafosse  and  Hertwig  have  ob- 
tained success  with  nitric  acid  injections,  and  Krantz  and  Schutt 
with  blisters.  Peyon,  Dandrieu,  Terrien  and  Obich  have  had 
good  results  with  the  direct  suture  of  the  ventral  walls  in  bovines, 
and  even  sohpeds.  Bouley  objects  to  the  suture  of  the  edges  of 
the  opening,  and  also  to  injections  into  the  evacuated  sac  of  irri- 
tating substances,  to  excite  inflammation  and  produce  the  adhe- 
sion of  its  walls.  We  have  ourselves  experimented  several  times 
with  the  subcutaneous  injections,  but  every  attempt  has  resulted 
in  failure.  According  to  Peuch  &  Toussaint,  if  old  ventral  her- 
nias are  to  be  treated,  the  best  plan  is  to  have  recourse  to  bandag- 
ing, as  employed  in  the  treatment  of  exomphalus. 

EVENTEATIONS. 

An  eventration  may  be  deflned  as  a  compound  hernia,  and  it 
constitutes  an  accident  of  the  first  degree  of  severity,  consisting 
in  the  formation  of  a  hernia,  of  indefinite  dimensions,  taking  place 
through  an  opening  involving  the  entire  thickness  of  the  abdomi- 
nal walls,  the  skin  included,  in  such  a  manner  that  some  portion 
of  the  abdominal  ^iscera,  but  most  commonly  the  intestines  or  the 
omentum,  become  directly  exposed.  Ordinarily  they  are  due  to 
some  traumatic  lesion,  such  as  a  thrust  from  or  a  fall  upon  a  sharp 
body,  or  they  may  be  produced  by  stab  wounds,  or  punctures  with 
a  fork  or  a  knife ;  or  again,  by  kicks  inflicted  by  other  animals,  or 
horn-blows,  when  cattle  are  crowded  into  too  contracted  a  space 
and  struggle  for  more  room,  or  quarrel  when  herded  in  pastures. 
And  they  quite  commonly  end  the  career  of  the  wretched  victims 
of  barbarity  which  are  compelled  to  assist  in  the  bloody  and  cruel 
sport  of  the  Spanish  buU  fight.  They  are  also  observed  at  times 
following  severe  surgical  manipulations,  as  in  castration,  during 
the  operation  for  strangulated  inguinal  hernia,  after  the  efforts  of 


448  OPEKATIONS    ON    THE    DIGESTIVE    APPARATUS. 

distokia.  They  may  also  form  one  of  the  complications  of  some 
of  the  forms  of  the  treatment  of  umbilical  hernia.  In  the 
smaller  animals,  such  as  dogs,  they  may  be  produced  by  a  severe 
bite  by  a  larger  animal. 

The  pathognomonic  symptom  of  an  eventration  may  be  con- 
sidered the  protrusion  of  a  portion  of  the  abdominal  contents 
through  its  lacerated  walls.  If  the  opening  through  which  this 
takes  place  is  small,  the  viscera  will  appear  as  a  small  round  tumor, 
which  presently  becomes  transformed  into  a  large  mass  of  intes- 
tinal circumvolution,  which  itself  varies  in  dimensions,  according 
to  the  extent  of  the  laceration.  As  the  exposed  intestines  begin 
to  protrude,  they  for  a  period  retain  their  physiological  appear- 
ance and  normal  color,  but  they  undergo  rapid  changes,  becoming 
progressively  darker,  blueish  and  then  black,  and  grow  cool  to  the 
touch.  The  viscera  as  they  protrude  from  the  abdomen  may  be 
quite  intact,  but  they  often  are  injured,  bruised  or  torn,  the  con- 
ditions varying  according  to  the  peculiar  circumstances  attending 
the  accident.  And  not  only  is  this  so,  but  the  sequel  of  the  case 
must  be  especially  considered,  since  an  eventration  which  possible- 
might  be  susceptible  of  cure,  if  carefully  tended  from  the  first, 
may  become  so  aggravated  and  exaggerated  as  to  preclude  aU 
possibility  of  remedy,  as  when  the  wounded  creature,  frantic  with 
pain,  from  colics  and  otherwise,  in  rearing  and  struggling,  forces 
his  entrails  more  and  more  out  of  their  place,  and  tears  and  tram- 
ples them  upon  the  earth  until  they  become  a  mere  mass  of  crushed 
and  bruised  viscera,  ground  into  the  earth.  And  yet,  colics  are 
not  always  present  in  eventrations,  even  in  horses  whose  irritable 
temper,  combined  with  the  condition  of  the  injured  parts,  would 
naturally  tend  to  render  their  occurrence  quite  inevitable. 

The  prognosis  of  their  injuries  varies  according  to  the  species 
of  the  animal,  and  also  under  the  special  condition  and  circum- 
stances of  each  case,  as  judged  by  itself.  In  horses,  it  is,  in  the 
majority  of  cases,  a  fatal  accident.  The  sensitiveness  of  the  animal 
to  impressions  upon  the  nerves,  and  the  delicate  susceptibHity  of 
the  peritoneum  account  for  this.  In  ruminants  they  are  less 
serious,  and  certainly  still  less  so  in  carnivorous  animals,  where 
sometimes  the  whole  intestinal  mass  may  be  seen  hanging  through 
the  laceration,  and  with  extensive  co-existing  inflammation,  with- 
out the  occuiTeuce  of  a  fatal  termination. 

Swine  are  also  very  sensitive  to  this  kind  of  injury,  though  the 


EVENTRATIONS.  449 

prognosis  may  vary  with  them,  according  to  the  condition  of  the 
lesion,  being  more  or  less  favorable  according  as  the  bulk  of  the 
protruding  viscera  is  less  or  greater.  The  chances  of  recovery 
will  also  vary  in  the  ratio  of  the  degree  of  the  exposure  of  the  vis- 
ceral organs  to  the  atmospheric  air,  or  to  the  severity  of  any 
traumatic  accidents  they  may  have  encountered. 

The  indications  of  treatment  suggested  in  these  cases  is  obvious. 
The  first  is  always,  when  practicable,  reduction.  To  return  the 
intestine  to  the  situation  designed  by  nature  for  its  occupancy  is 
the  first  step  to  take.  If  it  has  not  been  seriously  wounded,  and 
is  in  a  state  of  cleanliness,  and  has  escaped  contact  with  the  earth 
and  other  soils  and  stains,  simple  washing  may  be  attended  to  at 
once.  But  if,  on  the  contrary,  it  is  bruised,  soiled  and  inflamed, 
it  must  be  carefully  cleansed  with  warm  water,  before  being  re- 
turned to  its  position.  This  reduction  must  be  carefully  per- 
formed by  the  taxis,  and  if  the  opening  of  the  abdomen  is  too  small 
to  allow  this  to  be  accomplished  with  facility,  it  will  be  good  prac- 
tice-to enlarge  the  opening  with  the  knife,  rather  than  to  hazard 
the  too  free  manipulation  of  the  tender  parts  which  will  form  the 
dangerous  alternative  which  may  become  the  exciting  causes  of 
consecutive  inflammatory,  and  perhaps  gangrenous  sequelae.  If 
instead  of  the  intestines  the  eventration  allows  the  exit  of  the 
omentum,  this  also  must  be  cleaned  and  washed,  if  necessary,  and 
returned,  though  in  some  instances  it  may  be  torn  or  cut  off  after 
ligating  its  large  blood  vessels,  or  better  yet,  ligating  the  whole 
mass  with  animal  ligature.  The  second  step  of  the  Operation  con- 
sists in  appl;y'ing  means  of  restraint  to  retain  the  returned  organ 
and  prevent  a  second  exit.  The  quilled  suture  is  at  this  juncture 
the  means  which  always  first  suggests  itself  to  the  surgeon's  mind. 
The  clamps  have  their  advocates,  but  Zundel  prefers  the  metaUic 
interrupted  sutures.  The  entire  application  is  to  be  supported, 
reenforced  and  protected  by  a  wide  bandage,  similar  to  some  of 
those  recommended  in  umbilical  hernia. 

LAPAEOTOMY. 

This  operation,  which  consists  in  the  opening  of  the  abdominal 
cavity  through  the  loins  or  flanks,  is  one  which,  considering  the 
general  indication  for  which  it  is  performed  in  human  surgery, 
has  found  but  little  appHcation  and  occupies  but  a  small  place  in 


450  OPEKATIONS    ON    THE    DIGESTIVE    APPARATUS. 

veterinary  practice.  According  to  Director  Degives,  who  furnishes 
the  only  description  of  the  operation  to  which  we  have  been  able 
to  obtain  access,  the  indication  for  laparotomy  occurs  in  cases  of 
intestinal  invagination,  internal  hernia  and  intestinal  strangulation 
and  for  the  removal  of  foreign  bodies  from  the  abdominal  cavity 
or  the  intestinal  tract. 

Once  a  celebrated  surgeon  of  New  York  had  decided  to  prac- 
tice it  upon  one  of  his  valuable  dogs,  which  was  suffering  with 
impaction  caused  by  the  lodgement  of  a  mass  of  hair  in  the  intes- 
tines, which  we  fortunately  succeeded  in  softening  and  removing 
by  internal  treatment.  The  indications  for  the  operation  are  im- 
perative as  soon  as  a  fatal  result  becomes  imminent  and  certain. 
The  instruments  necessary  are  a  convex  bistouiy  and  suture  needles. 

Dr.  Degives  briefly  describes  the  operation  as  follows:  '^  jPosi- 
tion  and  Kestraint  of  the  animal  standing  up,  or  in  stocks,  or 
resting  against  a  wall  or  its  equivalent.  If  the  animal  is  restless 
let  him  be  thrown  down  on  the  side  opposite  to  that  of  the  opera- 
tion, which  is  divided  into  three  steps. 

First  Step,  opening  of  the  Jiank. — The  abdominal  opening 
must  be  in  the  upper  part  of  the  flank,  upon  a  line  between  the 
hip  and  the  last  rib.     This  opening  may  be  made  in  two  ways : 

1st,  or  Simple  Method. — It  consists  in  making  an  incision 
through  the  various  anatomical  layers,  in  the  same  direction,  in 
order  to  form  a  simple  vertical  wound,  large  enough  to  admit  the 
hand.  The  parts  ha\-ing  been  shaved,  the  division  of  the  skin,  the 
abdominal  muscles  and  the  peritoneum  is  made  successively  with 
the  convex  bistoury.  The  incision  of  the  deep  layers  alone  j)re- 
sents  any  difficvdty,  and  this  requires  some  attention,  the  hemor- 
rhage being  sometimes  troublesome ;  but  when  the  peritoneum  is 
exposed,  the  incision  is  increased,  from  without  inward,  with 
either  a  blunt  bistoury  or  the  straight  bistoury  controlled  by  a 
grooved  dii'ector,  an  assistant  protecting  the  intestines  from  the 
contact  of  the  instrument. 

2d,  or  N'eio  Method,  by  Gotnplex  Incision. — In  this  each  mus- 
cle is  divided  in  the  direction  of  its  own  proper  fibres.  Thus, 
the  first  is  a  transverse,  cutaneous  incision ;  second,  three  muscu- 
lar divisions,  running  in  directions  more  or  less  opposed  to  each 
other ;  the  first,  obliquely  downward  and  backward ;  the  second, 
obliquely  forward  and  downward,  and  the  third  transversal  and 
parallel  to  that  of  the  skin.     These  incisions  are  very  easily  made. 


LAPAROTOMY.  451 

little  more  being  necessary  than  a  simple  laceration  of  the  intesti- 
nal tissue  with  the  fingers — there  is  little  or  no  hemorrhage.  The 
opening  thus  made  admits  the  hand  into  the  abdomen,  and  when 
it  is  removed  the  fibres  of  each  muscle  having  a  tendency  to  come 
together  spontaneously,  the  opening  is  more  or  less  effectually 
closed. 

Seco7id  step. — This  varies,  to  correspond  with  the  object  of  the 
operation ;  1st,  whether  the  extraction  of  a  foreign  body  in  the 
abdomen  or  intestines,  or  2d,  the  reduction  of  an  invagination  or 
of  an  internal  hernia  (diaphragmatic,  mesenteric,  epiploic,  or  pan- 
creatic), and,  3d,  the  displacement  or  removal  of  a  tumor  involving 
the  intestines. 

In  the  reduction  of  an  internal  hernia,  it  may  be  necessary 
either  to  puU  or  to  push  upon  the  displaced  organ.  In  some  cases 
the  hernial  ring  must  be  enlarged,  and  if  that  cannot  be  done  with 
the  fingers,  the  bistoury  must  be  used.  The  reduction  of  an  intes- 
tinal invagination  is  obtained  by  the  combined  action  of  a  slight 
traction  on  the  invaginated  part  and  a  steady  external  j)i'essure 
upon  the  enlargement  formed  by  it  in  the  portion  of  the  intestines 
in  which  it  is  enfolded.  "WTien  the  swelling  of  the  organs  or  the 
presence  of  abnormal  adhesions  prevent  the  reduction,  the  traction 
must  be  increased  and  in  ojiposite  directions — the  invaginated  por- 
tion in  one,  the  enfolded  portion  in  the  opposite. 

If  a  stone,  a  calculus,  or  any  foreign  body  is  to  be  extracted, 
the  intestine  is  to  be  incised  at  some  distance  from  the  insertion 
of  the  mesentery,  on  its  lateral  face,  between  the  two  curvatures. 
On  the  removal  of  the  body  the  intestinal  suture  is  to  be  applied. 

Third  step,  Closing  the  Parietal  Wound. — AMien  the  complex 
incision  has  been  made,  a  strong  cutaneous  suture  is  all  that  is  re- 
quired. When  the  division  has  been  a  simple  one,  the  edges  of 
the  muscular  wound  are  brought  together  by  ordinary  interrupted 
sutures,  and  the  skin  is  afterward  sewed  up.  The  drainage  at 
the  lower  part  of  the  wound  is  always  advantageous." 

As  enteritis  and  peritonitis  are  common  sequelse  of  this  opera- 
tion much  care  and  watchfulness  devolve  on  the  surgeon  in  direct- 
ing the  regimen  and  nursing  of  the  patient  in  order  to  prevent  the 
possibility  of  their  access  from  becoming  a  certainty. 


CHAPTER  IX. 

OPERATIONS    ON    THE    RESPIRATORY 
APPARATUS. 

ON  THE  GUTTURAL  POUCHES— HYOVERTEBROTOMY. 

This  term  fails  to  meet  the  approval  of  Zundel,  who  has  pro- 
posed that  of  Ilyosjyondylotomy  as  a  substitute,  in  order  the  better 
to  indicate  the  puncture  of  the  sac  of  the  guttural  pouches  which 
it  signifies.  The  former  name,  however,  has  been  generally  ac- 
cepted, and  while  its  etymology  would  point  to  the  operation  by 
which  the  punctiu'e  referred  to  is  made  between  the  hyoid  bone 
and  the  atlas,  it  is  still  used  to  mean  generally,  the  puncture  of 
the  pouches,  at  whatever  point  it  may  be  made. 

These  guttural  pouches,  which  exist  exclusively  in  the  sohpeds, 
and  are  two  in  number,  are  situated  between  the  cranium,  the 
pharvTix  and  the  atlas,  resting  upon  each  otlaer  on  the  median 
Hne,  each  one,  by  an  expansion  of  the  miicous  membrane  of  the 
Eustachian  tubes,  forming  a  sac  and  filling  the  triangular  space 
situated  jiosterior  to  the  phar^Tix  and  extending  to  the  larynx.  The 
mucous  membrane  which  forms  them  is  easily  stretched,  and  the 
cavity  may  thus  become  greatly  distended  by  the  accumulation  of 
pus,  and  when  this  is  the  case,  the  pouch  extends  below  the  larynx 
and  the  lower  extremity  of  that  organ.  Thus  situated  in  the  parotid 
region,  these  two  sacs  sustain  important  relations  to  other  points, 
varying  according  to  -the  position,  whether  of  extension  or  flexion, 
of  the  head  uj^on  the  neck,  and  are  covered  by  seven  separate 
tissues,  as  represented  in  theu'  order  from  without  inward,  by 
1st,  the  skin ;  2d,  a  layer  of  subcutaneous  connective  tissue,  more 
or  less  abundant ;  3d,  a  thin  expansion  of  cutaneous  muscle  with 
the  parotido-auricularis  muscle ;  4th,  the  parotid  gland,  whose 
internal  face  is  moulded  upon  the  muscles  and  blood  vessels  un- 
derneath ;  5th,  the  following  muscles  in  the  order  as  named  from 
above  downward,  viz.,  the  small  oblique  of  the  head — the  stylo- 
hyoideus,  which  fills  the  space  left  between  the  anterior  border  of 


HYOVEETEBROTOMY- 


453 


Fig.  395.— Antero-Posterior  Section  of  the  Head,  showing  the  Mouth,  Fances, 
and  Nasal  Cavities. 

1,  genio-glossuB  muscle;  2,  genio-hyoideus  muscle;  3,  the  velum  palati;  4,  pharyn- 
geal cavity;  5,  CBsophagus;  6,  guttural  pouches;  7,  pharyngeal  opening  of  the  Eustach- 
ian tube;  8,  laryngeal  cavity;  9,  lateral  ventricle  of  the  iarynx;  10,  trachea;  11,  ethmoi- 
dal turbinated;  12,  maxillary  turbinated;  13,  ethmoidal  volutes;  14,  cerebral  compart- 
ment of  the  cranian  cavity;  15,  cerebellar  compartment  of  the  same;  16,  falx  cerebri; 
17,  tentorium  cerebelli;  18,  superior  lip;  19,  inferior  lip. 

the  styloid  process  of  the  occiiDital  bone  and  the  superior  border 
of  the  long  branch  of  the  hyoid,  through  which  the  puncture  is 
made  in  order  to  enter  the  guttural  pouches,  and  back  of  this  the 
stylo-hyoideus  and  the  superior  border  of  the  digastricus ;  then, 
6th,  on  the  deepest  layer,  the  guttural  pouches  are  found  supe- 
riorly, resting  intimately  on  the  internal  f^e  of  the  stylo-hyoideus 
muscle,  inferiorly  closely  cemented  with  the  posterior  face  of  the 
pharynx  and  posteriorly  with  the  superior  extremity  of  the  long 
muscle  of  the  neck ;  and  7th,  the  numerous  and  important  blood 
vessels  and  nerves  belonging  to  the  parotid  region. 


454 


OPERATIONS  ON  THE  KESPIEATORY  APPARATUS. 


Fig.  397.— Parotid  Kegion— Superficial  Layer. 
PP,  parotid  gland;  Mpa,  parotido-auricular  muscle;  3,  transveral  artery  of  the  face; 
4,  maxillo-muscular  vein;  7,  jugular  vein;  8,  glosso-facial  vein;  9.  transversal  vein  of 
the  face;   10,  maxillo-muscular  vein;  12,  posterior  auricular  vein;    13,    facial  nerve; 
15,  auricular  branch  of  the  2d  cervical  pair. 

The  arteries  are  tlie  three  divisions  of  the  primitive  carotid ; 
1st,  the  occipital,  which,  by  its  mastoid  branch,  runs  over  the  ex- 
ternal surface  of  the  styloid  process  of  the  occipital  bone ;  2d,  the 
internal  carotid,  which  runs  upward  through  the  thickness  of  the 
fold  of  the  mucous  membrane  which  forms  the  guttural  sacs ;  3d, 
the  external  carotid,  with  its  parotid  branches,  the  maxillo-mus- 
cuiar,  the  posterior  auricular,  the  superficial  temporal  trunk  and 
the  internal  maxillary      The  veins,  which  are  numerous,  empty 


H  YO  VERT  EBKO  TOHY. 


455 


Fig.  397.— Parotid  Region— Middle  Layer. 

P,  parotid  gland;  D,  digastricus  muscle;  Sh,  oocipito,  or  stylo-hyoideus,  muscle ; 
Sm,  sterno-maxillaris  muscle;  P,  thyroid  gland;  n,  posterior  border  of  the  great 
branch  of  the  hyoid  bone;  1,  primitive  carotid  artery;  2,  external  carotid  artery; 
3,  transversal  artery  of  the  face;  4,  maxillo-muscular  artery;  5,  posterior  auricular 
artery;  6,  thyro-laryngeal  artery;  7,  jugular  vein;  8,  gloaso-facial  vein;  9,  transversal 
vein  of  the  face;  10,  maxillo-muscular  vein;  11,  anterior  auricular  vein;  12,  posterior 
auricular  vein;  13,  facial  nerves;  14,  anterior  auricular  nerve. 

into  the  jugular  or  its  different  branches.  The  principal  nerves 
of  the  parotid  region  are  the  facial,  the  pneumogastric,  the  spinal, 
the  superior  cervical  ganglion  of  the  sympathetic,  the  great  hypo- 
glossus  and  the  glosso-pharyngeal.  These  nerves,  with  the  exception 
of  the  facial,  are  situated  on  the  external  face  of  the  pouches  below 
the  long  branch  of  the  hyoid  bone  and  the  stylo-hyoideus. 


456         OPERATIONS  ON  THE  RESPIRATORY  APPARATUS. 

This  rapid  summary  of  the  anatomy  of  the  parotid  region  ^^i]l 
sufficiently  indicate  the  dangers  which  the  surgeon  is  likely  to 
encounter  at  successive  steps  of  the  operation,  and  especially  if 
he  duly  considers  the  location  of  the  occipito-hyoideus,  which  must 
be  reached  before  the  puncture  can  be  made,  and  again,  the  j^ecu- 
liar  course  followed  by  the  posterior  auricular  artery  as  it  emerges 
from  the  parotid  to  reach  its  destination. 

Hyovertebrotomy  is  indicated  in  all  cases  of  repletion  of  the 
guttiu'al  pouches  resulting  from  a  purulent  collection  and  main- 
tained by  a  process  of  chronic  inflammation.  It  is  princiiDaily 
when  horses  have  become  Hable  to  be  attacked  vnth.  strangles  that 
these  purulent  collections  are  formed.  They  are  marked  by  an 
increase  of  size  in  the  pouches,  gradually  augmenting  with  the 
continued  formation  of  the  pus,  and  interfering  more  and  more 
with  deglutition  and  respiration,  sometimes  assuming  such  pro- 
portions as  even  to  threaten  suffocation.  Attacks  of  pharyngitis 
or  laryngitis,  or  catarrh  of  the  anterior  chambers  of  the  resjoira- 
tory  apparatus  and  nasal  cavities,  or  sinuses,  are  at  times  noticed 
in  connection  with  this  affection. 

To  revert  to  the  anatomical  arrangement  of  the  parts  :  The 
guttural  pouches,  opening  into  the  cavity  of  the  pharynx  by  a 
narrow  sHt,  are  situated  on  the  lateral  surface,  and  thus  allow  any 
collection  of  pus  they  may  contain  to  flow  wdthout  interruption 
into  the  pharynx,and  hence  into  the  other  nasal  ca\'ities.  We 
have  here  an  explanation  of  the  fact  that  a  discharge  from  the  nose 
in  any  one  of  a  variety  of  affections,  such  as  sujipuration  of  the 
guttural  pouches,  pharyngitis,  laryngitis,  catarrh,  and  also  the  dis- 
charo-e  of  glanders,  may  all  possess  different  characteristics,  and 
each  exhibit  a  different  aspect,  and  therefore  demand  a  different 
diagnosis  and  require  different  treatment. 

The  discharge  from  the  guttural  j^ouches  is  whitish,  glairy,  more 
or  less  mixed  with  mucosities,  inodorous,  non-adhesive  to  the  wing 
of  the  nose,  and  intermittent,  being  marked  dm-ing  mastication 
or  deo-lutition,  and  especially  while  swallowing  liquids — in  all  form- 
ino-  an  assemblage  of  characteristics  which  should  be  sufficient  to 
distinguish  the  affection  from  all  others.  There  is,  besides  this,  a 
negative  point,  in  the  absence  of  chancres,  which  with  the  distinct 
nature  and  peculiarity  of  the  discharge,  and  the  characters  so 
typical  of  the  maxillary  lymphatic  glands  in  that  disease,  will 
largely  aid  in  determining  the  difference  between  the  two  affections. 


HYOVERTEBKOTOMY.  457 

In  respect  to  glanders,  moreover,  the  bad  odor,  the  thick,  gru- 
mous  nasal  discharge,  and  the  soreness  and  dullness  on  percussion 
of  certain  parts  of  the  face,  will  in  many  cases  serve  to  identify 
and  distinguish  a  pathological  condition  of  the  sinuses  very  dif- 
ferent from  that  of  the  disease  we  are  considering.  Gohier  and 
Vatel  also  refer  to  guttural  tympanitis,  or  dilatation  of  the  pouches 
by  air,  as  a  featm-e  of  their  -disordered  condition.  The  amount  of 
pus  collected  in  the  pouches  varies  in  different  cases  to  such  an 
extent  that  from  only  a  trifling  degree  of  dilatation  it  may  be  suf- 
ficiently extensive  to  produce  a  sensible  projection  of  the  sac  below 
the  parotid.  This  dilation  furnishes  a  guide  for  the  determination 
of  the  proper  point  at  which  to  make  the  puncture,  whether  in  the 
upper,  in  the  middle,  or  in  the  lower  part  of  the  pouches.  The 
uj)per  operation  is  hyovertebrotomy  proper.  Besides  these  three 
modes  of  operation,  Gunther  has  proposed  a  fourth  method  which 
consists  in  penetrating  the  pouches  through  the  nasal  cavities. 

Upper  operation — Hyovertebrotomy  p)roper. — As  described  by 
Chabert  and  Fromage  de  Feugre,  this  is  one  of  the  finest  and  most 
delicate  operations  of  veterinary  surgery.  Extremely  so  when  per- 
formed on  horses  whose  pouches  are  healthy  and  normal  in  size, 
it  loses  a  great  deal  of  its  apparent  difficulty  when  these  are  full  of 
pus  with  prominent  and  well  developed  walls.  The  nerves  and 
blood  vessels  which  surround  them  are  then  easily  pushed  aside 
from  their  position,  and  the  lobules  of  the  parotid  are  more  or  less 
separated. 

The  instruments  required  for  this  operation  are:  a  pair  of 
scissors,  a  convex  and  a  straight  bistoury,  a  dissecting  forceps,  an 


Fig.  398.— Curved  Trocar,  or  Hyovertebrotome. 

S  probe,  or  preferably,  the  curved  trocar,  the  hyovertebrotome 
(Fig.  398),  and  a  piece  of  tape.  Artery  forceps  and  ligatures 
ought  to  be  always  within  reach. 

Bouley,  Zundel  and  others  recommend  that  the  animal  should 
be  kept  in  the  standing  position  with  simply  a  twitch  on  the  lip, 


458         OPERATIONS  ON  THE  RESPIRATORY  APPARATUS. 

but  our  experience  has  taught  us  that  the  recumbent  position  is 
the  safest,  especially  if  there  are  plenty  of  assistants  at  hand,  with 
instructions  to  keep  the  head  of  the  animal  steady,  and  in  a  mode- 
rate state  of  extension  on  the  neck. 

The  operation  is  divided  into  three  steps ;  1st,  The  incision  of 
the  skin  and  dissection  of  the  parotid ;  2d,  The  jyuncture  of  the 
pouch  through  the  occipito-hyoideus  muscle ;  and  3d,  The  estab- 
lishment of  the  counter-opening. 

Before  considering  these  three  steps,  it  will  be  well  to  answer 
sundry  important  questions  put  by  Lecoq  in  the  first  good  de- 
scription of  the  operation,  made  in  1841. 

'Where  shall  the  puncttire  he  made  ? 

The  anatomical  disposition,  which  we  have  already  examined, 
suggests  as  an  answer  to  this  query,  that  the  occipito-hyoideus 
inuscle  is  the  proper  place  for  the  puncture.  Its  inner  side  is 
lined  with  the  mucous  membrane  of  the  pouches,  and  as  has  al- 
ready been  remarked,  when  this  is  distended  by  fluid  and  becomes 
tense  and  resisting,  it  is  in  a  much  better  condition  for  the  pass- 
age of  the  knife  through  its  thickness  than  when  flabby  and  soft, 
and  therefore  movable  and  shifting,  as  if  endeavoring  to  evade  the 
knife.  At  any  other  point  the  pouches  are  so  surrounded  by  im- 
portant blood  vessels  and  nerves  that  the  operation  is  precluded 
by  the  ganger  which  would  be  incurred  by  attempting  it. 

Where  must  the  first  incision  he  made  to  reach  the  occipito- 
hyoideus  muscle? 

It  would  be  easy  to  reach  the  muscle  by  a  division  of  the  paro- 
tid gland,  bvit  this  would  involve  the  formation  of  a  fistula,  and  a 
wound  difiicult  to  heal,  to  avoid  which  the  gland  must  be  raised 
out  of  the  way.  This  should  be  done  by  raising  the  posterior  bor- 
der, where  it  is  loose  and  free  from  blood  vessels  or  nerves  of 
importance,  in  j)reference  to  doing  so  by  disturbing  the  anterior 
border  or  superior  extremity,  where  the  posterior  auricular  artery, 
the  facial  nerve  and  the  sub-zygomatic  artery  are  situated.  The 
superior  extremity  of  the  incision  must  begin  near  the  inferior 
border  of  the  tendon  common  to  the  splenius  and  small  com- 
plexus  muscles,  a  little  in  front  of  the  transverse  border  of  the 
atlas,  and  extend  downward  for  a  space  of  two  or  three  inches. 
Upon  v}hat  point  of  the  muscle  must  the  puncture  he  made? 

The  answer  to  this  is — upon  the  central  portion  of  the  muscle. 
The  introduction  of  the  bistouiy  into  the  superior  part  of  the 


HYOVERTEBROTOMY.  459 

muscle  will  involve  possible  danger  to  the  posterior  auricular  ar- 
tery, and  the  risk  of  the  division  of  the  facial  nerve. 

In  rohat  direction  must  the  sharp  edge  of  the  bistoury  be 
turned? 

The  reply  to  this  is  the  jyohU  of  minhmmi  danger  from  irregu- 
lar motions  of  the  instrument,  caused  by  the  struggling  of  the 
patient ;  and  this  result  is  most  likely  to  be  accomplished  by  carry- 
ing the  bistoury  towards  the  tuberosity  of  the  hyoid  bone,  and 
consequently  in  the  direction  of  the  patient's  nose.  With  the 
instrument  turned  towards  the  ear,  there  would  be  j)0ssible  dan- 
ger of  dividing  the  posterior  auricular  artery,  the  facial  nerve  or, 
perhaps,  the  internal  carotid. 

In  carrying  it  tow^ard  the  atlas,  the  internal  carotid,  and  the 
nerves  surroimding  it,  would  be  the  endangered  j^arts,  if  any.  If 
directed  do\\'nward,  toward  the  larynx,  a  division  of  the  great  hy- 
poglossus,  and  possibly  of  the  external  carotid,  might  be  possible. 

What  must  be  the  direction  of  the  instrument  ? 

If  the  bistoury  is  pushed  through  the  occipito-hyoideus  muscle, 
and  in  a  direction  perpendicular  to  it,  there  will  be  great  danger, 
at  a  certain  depth,  of  reaching  and  penetrating  through  the  in- 
ternal carotid  artery ;  but  if  an  obHque  direction  be  given  to  the 
instrument,  not  only  is  this  danger  avoided,  but  no  accident  be- 
yond some  slight  muscular  injury,  of  no  importance,  need  be  ap- 
prehended. 

Where  is  the  cotinter-openi?ig  to  be  made? 

The  right  place  will  be  the  most  dependent  part  of  the  pouches, 
and  the  instrument  used  must  be  either  the  S  probe  or  the  trocar, 
as  will  be  hereafter  described. 

These  preliminary  points  being  understood,  we  shall  the  more 
intelligently  follow  the  description  of  the  three  steps  of  the  opera- 
tion, which  we  now  proceed  to  give. 

1st.  The  Incision  of  the  Skin  and  Dissection  of  the  Posterior 
Border  of  the  Parotid. — This  incision  is  made  a  little  in  front  of 
the  transverse  process  of  the  atlas.  It  includes  the  skin  and  some 
subcutaneous  aj)oneurotic  fibres,  and  extends  to  the  posterior  bor- 
der of  the  parotid,  which  is  at  this  point  exposed.  With  the 
straight  bistom-y  and  dissecting  forceps,  the  parotid  border  is 
dissected,  and  under  it  the  aponeurosis  of  the  levator-humeri  is 
divided.  The  finger  is  then  pushed  between  the  aponeurosis  and 
the  small  oblique  muscle  of  the  head,  in  order  to  reach  the  occipito- 


460         OPERATIONS  ON  THE  RESPIRATORY  APPARATUS. 

hyoideus,  whicli  is  readily  identified  by  feeling  for  the  styloid  pro- 
cess of  the  occipital  bone  and  the  superior  border  of  the  long 
branch  of  the  hyoid.  Some  little  hemorrhage  and  some  strug- 
gling of  the  patient  may  follow  this  incision,  caused  by  the  divis- 
ion of  the  auricular  vein  and  nerve,  but  the  consequences  will  not 
be  serious. 

2d.  Puncture  of  the  Pouch  through  the  Muscle. — The  central 
point  of  the  muscle  being  identified,  the  operator,  with  a  straight 
bistoury  held  in  the  manner  of  a  writing-pen,  introduces  it  under 
the  parotid,  obliquely,  from  above  downward,  and  from  behind 
forward,  and  thus  divides  the  muscle  through  and  through,  and 
penetrates  the  pouch.  If  the  puncture  proves  to  be  sufficiently 
large,  the  index  finger  is  introduced  into  the  opening  for  explora- 
tion, and,  if  necessary,  for  its  further  dilatation. 

If  the  collection  of  pus  is  not  very  abundant,  and  the  mucous 
membrane  lining  the  sac  not  greatly  distended,  it  will  be  important 
to  have  a  very  sharp-pointed  instrument,  which  will  make  its  work 
of  incision  sure,  instead  of  merely  pushing  the  membrane  away 
from  the  internal  face  of  the  muscle — an  accident  which  might 
lead  to  serious  results. 

But  again,  when  the  collection  is  abundant  and  the  pouches 
much  distended,  the  use  of  the  bistoury  may  prove  unnecessary, 
the  puncture  being  then  readily  made  by  pushing  the  index  finger 
through  both  the  muscle  and  the  mucous  membi'ane  of  the  pouch. 

3d.  Making  a  Counter-Opening. — The  S  probe,  or  curved  tro- 
car (Fig.  398),  is  introduced  through  the  opening  made,  and  is 
pushed  down  to  the  bottom  of  the  pouch,  where  the  mucous  mem- 
brane is  easily  torn ;  it  is  then  carefully  directed  toward  a  point  a 
little  below  the  glosso-facial  branch  of  the  jugular,  back  of  the 
thick  border  of  the  maxillary  bone,  and  pushing  against  it  with 
sufficient  force,  the  instrument  forms  a  prominent  point  under 
the  skin.  If  the  S  probe  is  used,  an  incision  is  made  with  the 
bistoury  through  the  skin,  and  the  instrument  is  exposed.  If  the 
curved  trocar,  it  is  by  a  strong  pushing  movement  j^assed  thi-ough 
the  skin  and  brought  outside.  Whatever  instrument  may  be  used, 
a  piece  of  tape  or  kind  of  seton  is  introduced  from  the  lower 
through  the  upper  opening,  and  the  continued  escape  of  pus  thus 
facihtated  and  ensured.  The  extremities  of  this  piece  of  tape  are 
secured  together  by  tying  them  with  the  knot  used  with  the  or- 
dinary seton. 


HYOVERTEBROTOMT?. 


461 


The  attention  reqmred  by  the  patients  after  the  operation  is  of 
the  simplest  kind,  consisting  in  keeping  the  wounded  surface 
thoroughly  clean  and  keeping  up  the  flow  of  the  pus.  This  will 
at  first  make  its  escape  through  the  upper  opening,  but  will  soon 
find  its  way  through  the  lower  one,  and  so  long  as  it  is  discharg- 
ing the  opening  must  not  be  allowed  to  close,  nor  must  the  seton 
be  moved. 

Puncture  in  the  Middle  and  the  Lower  Regions  of  the 
Parotid. — These  modes  of  operation  are  so  nearly  identical  that, 
with  H.  Bouley,  we  think  they  may  with  propriety  be  jointly  con- 
sidered. 

In  these  cases  but  Httle  attention  to  the  anatomy  of  the  part 
is  required.  The  growth  of  the  purulent  collection  distends  the 
pouches,  displaces  the  blood  vessels  and  nerves,  separates  them 
more  or  less  from  the  parotid,  and  becomes  more  superficial,  and, 
in  fact,  may  idcerate  through  the  skin  and  empty  itself  spontane- 
ously. But  this  process  is  a  very  slow,  tedious  and  painful  one, 
and  subjects  the  patient  to  such  a  degree  of  suffering,  that  it  be- 
comes a  duty  imperative  to  interpose  the  resources  of  surgery  for 
its  relief. 

The  puncture  in  this  case  should  be  made  as  early  as  possible, 
and  at  the  fluctuating  point,  as  with  an  ordinary  abscess.  It  is 
made  with  the  bistoury,  or,  what  would  be  better,  with  the  oHvary 
actual  cautery,  by  which  the  prevention  of  hemorrhage  will  be  as- 
sured. The  opening  thus  made  and  cauterized,  wOl,  moreover, 
have  less  tendency  to  close  too  rapidly,  besides  which  the  modify- 
ing effects  of  the  cauterization  will  have  a  highly  advantageous  in- 
fluence upon  the  healing  process. 

The  opening  of  the  pouch  at  its  lower  extremity  has  been 
recommended  when  the  purulent  collection  is  small,  or  when  con- 
cretions of  inspissated  pus  are  supposed  to  exist  in  the  ca\'ities. 
It  is  done  by  first  dissecting  the  wide  and  thin  lower  portion  of 
the  parotido-auricularis,  then  of  the  base  of  the  parotid,  under 
which  the  distended  pouch  is  seen  and  punctured. 

We  remember  a  case  where  the  collection  in  both  cavities  was 
such  that  we  had  no  difficulty  in  opening  them  on  each  side  of 
the  neck,  about  on  a  level  with  the  thjToid  glands,  the  lower 
operation  with  emphasis ! 

Puncture  Through  the  Eustachian  Tubes. — Gunther  has  in- 
vented a  tube,  rounded  at  one  extremity,  a  sort  of  hollow  bougie. 


462         OPERATIONS  ON  THE  KESPIEATORY  APPARATUS. 

which  he  introduces  into  the  guttural  pouches  by  passing  it 
through  the  nasal  cavities  and  the  Eustachian  tubes.  Although 
in  performing  this  operation  the  animal  is  thrown  down,  it  is  very 
difficult  to  accomplish,  and  requires  to  be  preceded  by  the  operation 
of  tracheotomy.  It  also  requires  to  be  repeated  several  times,  by 
reason  of  the  hability  of  the  collection  to  return. 

The  mode  of  operation  is  a  matter  of  no  importance,  since  the 
solutions  of  continuity  resulting  from  it  seldom  assumes  a  form 
more  serious  than  that  of  an  ordinary  simple  wound,  and  requir- 
ing no  special  directions  as  to  treatment.  Even  ordinary  de- 
tergent washes  are  scarcely  necessary. 

LAEYNGOTOMY— AKYTENECTOMY. 

The  history  of  surgical  interference  at  the  larynx,  to  relieve  the 
pecuhar  difficidty  of  respiration  known  as  roaring,  depending 
upon  j)ai"alysis  of  the  laryngeal  muscles,  dates  as  far  back  as  1845, 
when  Professor  Gunther,  of  Hanover,  attempted,  in  succession,  the 
resection  of  the  vocal  cords,  the  removal  of  the  vocal  cord  of  the 
paralyzed  side  of  the  larynx,  the  partial  excision  of  the  arytenoid 
cartilage,  the  entire  extirpation  of  that  cartilage,  the  removal  of 
the  vocal  cord  and  of  the  corresponding  laryngeal  ventricule,  and 
finally  the  fixation  of  the  arytenoid,  by  an  anchylosis  at  its  artic- 
xdation  with  the  thyroid  cartilage.  The  resiilts  obtained  by  Gun- 
ther were  more  or  less  successful. 

These  experiments  were  repeated  by  Gerlach,  H.  Bouley, 
Stockfelth  and  Bassi,  but  subsequently  repudiated  and  ignored. 
But  in  later  years  Professor  Moller,  of  Berlin,  and  George  Flem- 
ing, of  London,  have  turned  their  attention  to  the  subject,  with  the 
suggestion  of  various  new  modes  of  operating,  which  have  yielded 
resTilts  more  or  less  encouraging.  The  matter  has  been  followed 
up  by  other  veterinarians  in  various  parts  of  the  world,  and  re- 
cently especially  by  Professor  Cadiot,  and  the  successes  which 
have  been  recorded,  though  not  always  perfect,  seem  to  justify  the 
prosecution  of  further  inquiries  and  new  trials  for  the  relief  of  a 
disease  which  has  thus  far  bafEed  the  skill  of  vetei-inarians,  and 
consigned  manj^  a  valuable  animal  to  the  hands  of  the  knacker. 

The  operation  of  Professor  Moller,  also  recommended  by  Pro- 
fessor Cadiot,  as  at  present  practiced,  is  the  excision  of  the  para- 
lyzed cartilage.     That  of  George  Fleming  is  the  removal  of  the 


LARYNGOTOMY ARYTENECTOMY, 


463 


cartilage  and  the  vocal  cord.  "We  shall  describe  the  Fleming  and 
Cadiot  modes  as  we  find  them  recorded  in  their  own  works, 
"  Roaring  in  Horses,"  by  the  former,  and  "  The  Surgical  Treat- 
ment of  Chronic  Roaring,"  by  the  latter. 

The  Fleming   Method. — The  special  instruments  necessary 
are  small  ordinary  forceps;  scalpels;  bvdl-dog  forceps;  tracheal 


Fig.  399  —Tracheal  Tampon  Canula. 


tampon ;  a  canula,  formed  of  a  long  tracheotomy  tube,  with  ah 
india  rubber  bag  surrounding  its  middle.  This  bag  is  inflated 
by  means  of  an  india-rubber  air-pump,  after  the  insertion  of  the 
tube  into  the  trachea,  and  is  useful  in  preventing  the  flow  of  blood 
into  the  bronchii  during  the  horse's  getting  up  after  the  operation, 
and  for  half  an  hour  subsequently.  Other  instruments  required 
are  a  razor-shaped  knife,  with  which  to  excise  the  cartilage ;  a  bent 
knife  with  which  to  remove  the  muscles  from  the  outside  of  the 
arytenoid   cartilage  ;  a  hook  to  seize  and  raise  the  lower  end  of 


Fig.  402.— Hook  to  Secure  the  Cartilage. 


464         OPERATIONS  ON  THE  RESPIRATORY  APPARATUS. 


Fig.  406.— Electric  Lamp. 

the  cartilage ;  a  special  forceps  with  toothed  ends,  to  seize  the 
body  of  the  cartilage ;  cui'ved  scissors  to  cut  through  the  mucous 
membrane  ;  two  retractors  to  keep  the  trachea  opened  during  the 
operation  ;  and  an  electric  lamp  to  illuminate  the  interior  of  the 
lar;yTix. 

Fleming  describes  the  operation  as  follows:  "The  horse 
should  be  well  fed  for  a  day  or  two  preceding  the  operation,  but 
have  little  or  no  food  or  drink  for  some  hours  before  its  actual 
performance.  In  the  case  of  thoroughbred  horses,  a  dose  of  four 
ounces  of  tincture  of  opium  in  a  pint  of  water,  half  an  hour  be- 
fore operating,  is  a,dvisable.  The  hair  must  be  removed  closely 
from  around  the  upper  part  of  the  trachea  and  larjnix,  before  the 


LAKYNGOTOMY AKYTENECTOMY.  465 

animal  is  cast,  and  he  is  thi'own  in  the  usual  manner,  on  a  good 
bed  of  straw  or  moss  or  litter.  The  chloroform  bag  is  put  on,  and 
when  the  requii-ed  state  of  narcosis  is  induced,  the  animal  is  placed 
on  his  back,  and  maintained  there  by  sacks  filled  with  straw,  placed 
close  under  each  side  of  the  body.  The  neck  and  head  are  ex 
tended  in  a  Une  with  the  body,  the  head  placed  on  the  vertex  and 
kept  steady  by  an  assistant.  The  operator  places  himself  in  a 
kneeling  position,  on  the  off,  or  right  side  of  the  body,  if  right 
handed,  beside  the  neck,  with  his  back  to  the  shoulder  and  face 
toward  the  head." 

The  operation  is  divided  into  three  stages : 

First  Stage. — "  With  a  scalpel,  an  incision  of  from  four  to  six 
inches  in  length  is  made  through  the  skin,  the  middle  line  of  the 
larynx  and  trachea,  opposite  the  posterior  border  of  the  lower  jaw, 
extending  from  the  body  of  the  thyroid  cartilage  to  the  second  or 
third  tracheal  ring.  This  exjjoses  the  subscai:)ulo-hyoid,  sterno- 
hyoid and  sterno-thyroid  muscles,  which  are  incised  to  the  same 
extent,  and  as  close  as  possible  to  their  line  of  junction  {rax)he) 
in  the  middle,  the  section  being  then  carried  through  to  the  larynx 
and  trachea.  There  is  a  variable  amount  of  hemorrhage  now  to 
contend  with,  which,  if  only  oozing,  may  be  checked  by  sponging 
it  dry  until  the  blood  has  ceased  to  flow ;  and  if  it  comes  from 
twigs  of  arteries  or  veins,  they  may  be  seized,  and  twisted,  or 
ligated." 

Second  Stage. — "The  middle  crico-thyroid  ligament,  cricoid  car- 
tilage, and  one,  two  or  three  tracheal  rings  are  cut  through,  in  a 
straight  line,  exj^osing  the  interior  of  the  larynx  and  trachea.  If 
blood  vessels  are  cut,  they  should  be  taken  up.  A  retractor  is 
applied  to  the  sides,  and  these  being  pulled  gently  apart  by  an 
assistant,  there  is  amj^le  space  in  which  to  manii^ulate.  The  con- 
vex lower  border  of  the  arytenoid  on  each  side  can  now  be  seen, 
and  if  the  respiration  is  deep,  that  which  is  next  the  operator  (the 
right),  will  be  observed  to  move  actively  from  the  side  toward  the 
middle  ;  while  if  the  roaring  is  due  to  paralysis  of  the  left  dilator 
muscle,  there  is  no  movement  in  the  opposite  cartilage.  "WTien  the 
breathing  is  very  tranquil,  which  is  often  the  case,  the  right  carti- 
lage moves  almost  imperceptibly,  and  it  becomes  necessary  to  as- 
certain whether  the  left  one  is  really  immovable.  This  can  be 
done  by  passing  the  finger,  or  a  long  probe,  up  toward  the  epi- 
glottis, when  the  act  of  swallowing  will  be  excited,  during  which 


466 


OPEEATIONS    ON    THE    KESPIKATOEY    APPARATUS. 


the  right  arytenoid  cartilage  is  energetically  jerked  into  the  mid- 
dle of  the  cavity ;  but  the  left  one  is  either  motionless  or  only 
feebly  stirs,  dejjending  iipon  the  degree  of  the  wasting  of  the  con- 
strictor muscles  on  that  side. 

"  If  any  blood  lodges  in  the  trachea,  it  can  be  removed  by 
large  or  small  (handled)  sponges,  which  may  be  passed  to  the 
operator  by  an  assistant  who  receives  and  washes  them.  As  the 
horse  is  now  breathing  through  the  wound,  the  chloroform  bag 
may  be  removed. 

"It  is  always  advisable  to  examine  the  interior  of  the  larynx 
carefully,  in  order  to  ascertain  its  exact  condition,  as  there  may  be 
something  more  in  the  case  than  an  immovable  cartilage.  For  this 
purpose  the  electric  lamp  is  invaluable. 


Fig.  407.— Left  Side  Section  of  Larynx,  showing  the  Parts  excised  in  the  OperatloB 
for  Eoaring. 

'*  The  left  arytenoid  cartilage  may  be  excised  by  commencing 
at  the  lower  convex  border,  or  at  the  ujoper  part,  where  it  meets 
the  right  cartilage  (Fig.  407).  If  the  latter  method  is  selected, 
then  a  cut  with  a  razor-shaped  knife  is  made  through  the  mucoua 


LAEYNGOTOMY ARYTENECTOMY.  467 

membrane,  into  the  aiytenoid  ligament  and  arytenoid  muscle,  as 
close  to  the  margin  of  the  cartilage  as  possible,  beginning  between 
the  cartilage  of  Santorini,  downward  and  then  upward  and  the 
vocal  process  at  the  insertion  of  the  vocal  cord  (Fig.  407).  The 
hook  is  inserted  in  the  vocal  process,  which  is  raised,  and  the 
vocal  cord  is  separated  from  the  cartilage  by  the  scissors  ;  then 
the  muscles  on  the  outside  of  the  cartilage  are  cut  with  the  bent 
knife,  or,  what  is  better,  pushed  from  its  surface  as  close  as  possi- 
ble. The  hook  is  removed,  and  the  body  of  the  cartilage  seized 
with  the  rachet  forceps.  The  mucous  membrane  connecting  the 
cartilage  with  the  vocal  pouch  is  divided,  with  the  curved  scissors, 
cutting  as  close  to  the  cartilage  as  possible,  to  save  the  membrane. 

"  The  arytenoid  cartilage  is  now  free,  except  at  its  articula- 
tion with  the  cricoid,  and  it  may  either  be  disarticulated  or  cut 
through  with  the  scalpel  at  this  point,  care  being  taken  to  leave 
no  loose  portions  or  shreds.  The  cartilage  being  now  only  retained 
by  the  soft  parts  at  the  upper  portion  (or  base  of  the  arytenoid 
cartilage),  these  are  cut  through,  close  to  it,  vnth  the  scissors,  when 
it  is  altogether  detached. 

"  Care  must  be  taken  to  avoid  wounding  the  other  cartilages, 
or  the  pharyngeal  mucous  membrane,  and  to  spare  that  membrane 
in  proximity  to  the  arytenoid  cartilage  as  much  as  possible,  remov- 
ing only  that  which  covers  its  surface  and  the  cartilage  of 
Santorini. 

"  The  vocal  cord  is  noAv  removed  close  to  its  attachment  to  the 
thyroid  cartilage,  in  front  and  at  its  fixed  border  (Fig.  407).  This 
can  be  done  with  the  scissors,  a  finger  being  passed  to  the  bottom 
of  the  ventricle  to  facilitate  the  excision  ;  or  the  cord  may  be 
drawn  from  the  side  by  inserting  a  hook  in  it,  to  allow  plenty  of 
room  for  the  scissors. 

"  If  the  hemorrhage  is  troublesome,  which  it  seldom  is,  the 
blood  can  be  mojDped  out  of  the  trachea  with  the  sj)onges.  It 
cannot  pass  down  that  tube,  owing  to  the  position  of  the  neck. 
If  necessary,  the  electric  lamp  may  be  employed  to  ascertain  how 
the  operation  has  been  performed,  or  even  during  it  performance  ; 
but  after  a  little  experience  this  is  unnecessary." 

Third  Stage.  —  "The  trachea  being  completely  freed  from 
blood,  and  the  tampon  canula  introduced,  the  bag  being  inflated 
after  it  has  been  properly  placed  into  the  trachea  by  means  of  the 
air-pump,  the  canula  is  secured  in  position  by  a  tape  around  the 


468         OPERATIONS  ON  THE  EESPIRATORY  APPARATUS. 

neck.  It  is  only  required  for  about  half  an  hour,  until  the  hemor- 
rhage has  ceased,  as  it  will  prevent  the  entrance  of  blood  into  the 
lungs  while  the  horse  is  getting  uj).  and  for  a  short  time  after- 
ward respiration  being  carried  on  throvigh  the  tube.  It  ought 
not  to  be  left  any  longer,  being  liable  to  injure  the  interior  of  the 
trachea.  The  blood  being  again  removed  from  the  larynx,  one  or 
two  syringe-fulls  of  the  common  salt  or  borax  solution  are  inject- 
ed into  it  and  the  pharynx.  This  washes  out  these  cavities  and 
the  sinuses  of  the  head,  a  necessary  precaution,  as  putrefying 
blood  in  them  sometimes  gives  rise  to  troublesome  consequences. 
Swallowing  should  be  induced  by  touching  the  epiglottis,  and 
then  the  horse  may  be  turned  on  his  side,  the  lower  margin  of  the 
wound  being  depressed,  to  allow  the  remaining  blood  and  water 
to  flow  out.     This  completes  the  operation. 

"  The  horse  is  nowR^  allowed  to  recover  from  the  chloroform? 
and  when  ready  he  may  be  assisted  to  get  upon  his  feet,  care 
being  taken  that  the  canula  is  not  displaced  while  doing  so.  The 
wound  is  kept  open  with  the  finger  for  a  short  time,  to  allow  any 
remaining  blood  to  escape,  and  it  is  afterward  cleansed  away  from 
around  the  wound,  the  face  and  nostrils  sponged  to  refresh  the 
patient,  and  if  the  weather  is  cold,  the  body  clothed  and  the  legs 
bandaged." 

Method  of  Cadiot. — The  special  instruments  required  are  a 


Fig.  408.— Blunt  Bistoury. 


Fig.  409.— Curved  SclsBors.  Fig.  410.— Spring  Tenaculum,  or  Dilator. 

blunt  bistoury,  curved  scissors,  whose  blades  are  nearly  perpen- 
dicular to  the  branches,  a  spring  tenaculum,  a  hooked  or  long 
bull-dog  forceps,  a  canula  tampon,  like  that  used  by  Fleming,  a 


LARYNGOTOMY ARYTENECTOMY.  469 


Fig.  411.— Hooked  Forceps. 
peculiar  curved  needle,  shown  in  Figure  418,  straight,  long  and 
ordinary  curved  scissors,  bistouries,  dissecting  forceps,  artery  nip- 
pers, loose  and  fixed  sponges,  thread,  cotton,  pheniated  or  iodo- 
formed  gauze,  and  antiseptic  solutions. 

The  preparation  of  the  animal  is  similar  to  that  in  Fleming's 
method. 

First  Stage. — Incision  of  the  Skin  and  Muscles  covering  the 
Larynx. — The  incision  must  be  made  on  the  median  line,  and  ex- 
tend from  the  body  of  the  thyroid  to  the  second  or  third  tracheal 
ring.  This  is  done  with  the  convex  bistoury,  first  dividing  the 
skin  in  its  whole  length,  when  the  edges  separating  show  the 
raphe  of  the  sterno-hyoid  and  omoplat-hyoideus  muscles.  The 
muscular  layer  can  then  be  divided  exactly  ujDon  the  median  line. 
The  division  of  the  prelaryngeal  connective  tissue  closes  the  first 
stage.     The  hemorrhage  is  always  hght  and  easily  controlled. 

Second  Stage. — Incision  of  the  Larnyx  and  of  the  First  Two 
Mings  of  the  Trachea,  Introduction  and  Fixation  of  the  Can- 
tda. — The  incision  may  be  made  by  a  single  stroke  of  the  knife, 
dividing  the  crico-thyroid,  and  with  it,  successively,  the  cricoid 
and  the  crico-tracheal  ligaments,  and  the  first  rings  of  the 
trachea.  But  by  this  mode  of  operation,  the  vocal  cords  may  be 
injured,  and  to  avoid  this,  the  bistoury  held  perfectly  vertical, 
with  the  edge  turned  backward,  is  inserted  through  the  crico-thy- 
roid Hgament,  immediately  in  front  of  the  cricoid  cartilage,  and 
this  is  divided  with  the  crico-tracheal  ligament,  as  well  as  the  first 
ring  of  the  trachea.  The  edges  of  the  laryngo-tracheal  incision 
are  then  opened  with  the  spreaders,  or  the  spring  tenaculum,  and 
the  division  of  the  thyro-cricoid  ligament  is  completed,  from  be- 
hind forward,  and  from  within  outward.  As  by  the  act  of  inspi- 
ration the  vocal  cords  move  more  or  less  outward,  this  movement 
should  be  carefolly  watched  while  making  the  incision  of  the 
crico-thyroid  membranes  to  save  them  from  injury.  The  canula- 
tampon  is  then  introduced,  and  when  in  place,  is  moderately  in- 
flated by  an  assistant,  the  operator  measuring  the  degree  of  dila- 


470 


OPEEATIONS  ON  THE  RESPIRATORY  APPARATUS. 


tation  with  his  fingers  in  the  superior  part  of  the  trachea.  When 
it  is  sufficiently  expanded,  a  ligature  is  applied  upon  the  India 
rubber  tube,  and  this  is  cut  off.     Though  the  tampon  is  inflated, 


Fig.  412.— Arytenectomy.  The  second  step  is  over.  The  crico-thyroid  ligament,  cri- 
coid cartilage,  crico-tracheal  ligament  and  the  two  first  tracheal  rings  are  divided. 
The  canula  and  the  tenaculum  are  in  place— tc.  Cricoid  Cartilage.  IE,  First  King  of 
the  Trachea. 

the  canula  has  a  tendency  to  slip  in  the  lar\Tix,  and  for  the  pre- 
vention of  this  accident  should  be  secured  by  bands  or  strings  tied 
backward  over  the  neck. 

Third  /Stage.  —  Ablation  of  the  Arytenoid  Cartilage. — The 
ablation  of  the  cartilage  is  effected  by  several  stej)s : 

{a)  Incision  of  the  Mucons  Membrane  along  the  Superior 
and  Posterior  Borders  of  the  Cartilage. — With  a  blunt  bistomy 
and  a  slight  pressui-e,  an  incision  is  made  in  the  mucous  mem- 
brane along  the  side  of  the  superior  and  posterior  borders  of  the 


LAEYNGOTOMY AEYTENECTOMY.  471 

ai'vtenoid  (see  Fig.  413),  the  instrument  being  then  carried  into 
the  larynx  on  the  median  line,  from  before  backward  to  the  cri- 
coid, and  thence  from  within  outward  and  from  below  upward,  as 
far  as  the  insertion  of  the  vocal  cord.     To  save  the  mucous  mem- 


1.1 


\ 


v„. 


y 


Fig.  413.— Sd  Step,    a,  Incision  of  tlio  Mucou.s  ^Jonibiviuo  aioug  the  Superior  and  Pos- 
terior Borders  of  the  Arytenoid. 

brane,  the  incision  may  be  made  at  some  distance  from  the  bor- 
ders of  the  cartilage,  but  the  division  of  the  membrane  must  be 
complete. 

{b)  Section  of  the  Vocal  Cord ;  Dissect io?i  of  the  Cartilage 
on  its  Inferior  and  Anterior  Borders  and  External  Face. — With 
long,  sharp,  sti-aight  scissors,  the  vocal  cord  is  excised  at  its  in- 
sertion upon  the  arytenoid  (see  Fig.  414).  The  cartilage  is  then, 
by  small  nips  of  the  scissors,  made  from  behind  forward,  dis- 
sected in  dividing  the  mucous  membrane  along  its  inferior  bor- 
der, and  the  muscular  fibres  of  the  crico-arytenoid  and  thyro-ary- 
tenoid,  inserted  on  its  external  face  (Fig.  415);  the  mucous  mem- 
brane, which  covers  the  anterior  border,  being  divided  from  above 


472 


OPEBATIONS  ON  THE  RESPIRATORY  APPARATUS. 


Fig.  414.— 3d  Stn-).     b,  Section  of  the  Vocal  Cord. 


downward  with  the  scissors.  To  facilitate  this  part  of  the  oper- 
ation, the  cartilage  must  be  firmly  held  with  either  the  hooked  or 
the  bull-dog  forceps,  and  carried  toward  the  median  line,  when 
the  inferior  border  and  the  external  face  are  dissected,  and  drawn 
backward  and  upward  when  the  dissection  goes  on,  on  the  ante- 
rior border.  The  only  important  or  jiarticular  caution  needed 
here,  is  to  hold  the  point  of  the  scissors  always  m  contact  with 
the  cartilage,  to  keep  close  to  it,  to  save  the  mucous  membrane, 
and  to  avoid  the  larjTigeal  ventricle  as  well  as  the  tissues  loosened 
from  the  external  face  of  the  cartilage.  Toward  the  end  of  this 
thu'd  step,  when  the  cartilage  is  separated  from  the  fibres  of  the 
thyro-arytenoid  muscle,  a  hemorrhage  takes  place  from  the  divid- 
ed laryngeal  branch  of  the  thyroid  artery  (Fig.  416).  This  must 
be  controlled  by  torsion  or  artery  nippers. 

(c)  Section  of  the    Cartilage  near  its  Articulation  with  the 


LAEYNGOTOMY ARYTENECTOMY. 


473 


Fig.  415.— 3(f  Ste2}     b,  Dissection  of  the  Arytenoid  at  its  Inferior  Border  and 
its  External  Face. 


Cricoid. — Eaised  and  immobilized  with  a  strong  forceps,  or  the 
hook  forceps,  held  with  the  left  hand,  the  arytenoid  is  separated 
from  without  inward  near  its  postero-superior  angle,  the  articu- 
lar, with  the  blimt  bistoury.  Held  in  a  vertical  direction,  or  some- 
what obHquely  downward  and  forward,  the  bistoury  is  moved  to- 
ward the  external  part  of  the  arytenoid,  immediately  in  front  of 
the  cricoid,  and  the  section  is  made  by  a  limited  and  careful  saw- 
ing motion.  "WTaen  the  arytenoid  is  partially  ossified,  which  is  a 
condition  encountered  in  nearly  one  half  of  the  patients,  some 
force  may  be  used.  A  feeling  of  cessation  of  resistance,  and  an 
increased  mobility  of  the  cartilage,  indicates  the  completion  of  the 
section. 

(d)  Dissection  of  the  Cartilage  by  its  Siq^erior  Face  (Fig.  ilTV 
— This  is  done  with  the  curved  scissors.     The  cartilage  being  weU 


474 


OPERATIONS  ON  THE  EESPIKATOKY  APPARATUS. 


Aj^ 


Fig.  416.— 5c?  step,    c,  Section  of  the  Arytenoid  near  its  Articular  Angle. 
A,  Laryngeal  Branch  of  the  Thyro-Laryngeal  Artery. 

raised  with  the  forceps,  the  scissors  are  introduced  under  its  poste- 
rior portion,  with  the  branches  held  almost  vertically,  and  close  to 
the  cartilage,  from  behind  forward,  and  the  fibres  of  the  arytenoid 
muscle  are  nipped  off.  With  careful  attention,  the  perfect  dissec- 
tion of  the  entire  cartilage,  including  its  beak,  may  be  effected. 
During  this  part  of  the  operation,  blood  and  pharyngeal  mucosi- 
ties  may  interfere  with  the  manipulations,  and  must  be  removed 
with  pieces  of  soft  cloth,  wadding  or  sponges. 

When  these  various  manipulations  have  been  well  executed  as 
described,  the  surface  left  by  the  loss  of  substance  presents  a  neat 
and  smooth  appearance,  not  only  on  its  borders,  but  over  its  en- 
tire extent.  Professor  Cadiot,  in  this  step  of  the  operation,  omits 
the  excision  of  the  vocal  cord,  which  he  considers  unnecessary. 

Fourth  Stage.  Suture. — The  borders  of  the  wound  are  brought 


LARYNGOTOMY ARYTENECTOMY. 


475 


FiG.  417.— Sd  Step,    d.  Excision  of  the  Cartilage  with  the  Curved  Scissors. 

together  with  two  or  three  interrupted  catgut  sutiu-es,  made  with 
«,  special  needle  (Fig.  418).  Three  of  these  are  generally  re- 
quired (Fig.  419). 

After  cleansing  the  larynx  of  the  blood,  it  is  di'essed  with  wad- 
ding or  iodoformed  gauze.  The  edges  of  the  external  wound  are 
brought  together  by  two  interrupted  sutures,  one  upon  the  mus- 
cular coat,  the  other  on  the  skin,  the  latter  being  so  placed  as  to 
prevent  the  displacement  of  the  canula. 

The  care  of  the  wound,  aside  from  the  matters  of  cleanhness 
and  the  application  of  antiseptic  measures,  varies  according  to  the 
two  modes  of  operation.  But  they  agree  in  advising  the  early 
removal  of  the  canula  at  a  period  not  later  than  the  day  following 
that  of  the  operation. 

Careful  diet  is  indicated,  but  Fleming  advises  strict  fasting 
from  both  food  and  water  for  two  or  three  days,  while  Cadiot  per- 
mits the  animal  to  have  his  ordinary  diet  without  interruption. 


476         OPERATIONS  ON  THE  RESPIRATORY  APPARATUS. 


Pig.  i\8.—Uth  Step.    How  to  Apply  the  Sutures. 

There  is  no  serious  febrile  reaction,  and  after  three  or  four  weeks 
the  cicatrization  is  complete. 

The  result  of  the  operation  cannot  be  fully  ascertained  until 
about  three  months  after  the  operation,  when  the  animal  can  be 
tested. 

The  application  of  the  sutures  constitutes  an  improvement,  we 
believe,  on  Fleming's  oj)erations  for  assisting  the  cicatrization  of 
the  laryngeal  wound,  which,  however,  can  be  more  easily  watched 
if  the  external  sutures  recommended  by  Cadiot  are  dispensed 
with.  Excessive  granulations,  when  detected,  must  be  cauterized 
with  chloride  of  zinc  or  nitrate  of  silver. 

Among  the  accidents  and  complications  that  may  follow  ary- 
tenectomy,  and  which  are  mentioned  by  Fleming  and  Cadiot,  are 
wounds  of  the  mucous  membrane  and  of  the  arytenoid  left  in  the 
larynx,  incomplete  deglution  of  the  dressing,  pneumonia  from 


[■RACHEOTOMY. 


477 


Fig.  419.— The  Sutures  are  in  Place ;  three  are  necessary. 

foreign  bodies,  excessive  granulations  of  the  cicatrix,  pyemia, 
tetanus,  besides  those  which  result  from  the  division  of  the  carti- 
laginous structure,  such  as  deformity  of  the  tracheal  rings,  and 
the  contraction  of  the  tracheal  diameter. 


TRACHEOTOIVIT. 

This  term  represents  an  operation  consisting  in  making  a 
methodic  opening  of  varying  dimensions,  in  the  cervical  position 
of  the  trachea,  in  order  to  provide  a  free  channel  for  the  atmos- 
pheric ail'  into  therespu'atory  tract.  Its  ultimate  object  is  either  the 
removal  of  foreign  bodies,  or  of  the  abnormal  growth  from  the 
larynx,  or  to  facilitate  the  passage  of  the  air  necessary  to  respira- 
tion. Its  subjects  are  principally  the  large  domestic  animals,  more 
especially  the  horse,  and  it  has  also  been  employed  with  advantage 
on  ruminants,  and  often  successfully  on  dogs. 


478 


OPERATIONS  ON  THE  RESPIEATOKY  APPARATUS. 


The  importance  of  the  operation,  with  its  utility,  is  readily 
demonstrated  by  studying  the  e£fect  of  its  performance,  and  esti- 
mating the  relief  which  immediately  follows,  in  some  special  cases 
of  ailment  or  accidents,  complicated  with  the  danger  of  immi- 
nently  impending  suffocation.  It  is  performed  in  the  middle  of 
the  inferior  border  of  the  neck,  in  that  portion  where  the  trachea 


'ii|;^y; 


Pig.  520.— Tracheal  Region.    T,  Trachea;  A  A,  Sterno-Hyoideus  and  Thyroideus  Mus- 
clee;  S  H,  Sub-Scapulo-Hyoideus ;  if  M,  Sterno-Maxillaris ;  J,  Jugular  Vein. 


being  most  subcutaneous,  can  be  readily  felt,  in  the  lozenge 
formed  by  the  diverging  branches  of  the  stemo-maxillaiy  muscles 
below,  and  the  two  converging  sub-scapulo  hyoideus  above.  The 
trachea  is  here  merely  covered  by  the  subcutaneous  band  of  the 
sterno-hyciaeus  and  sterno-thyroideus,  and  tLe  whole  is  wrapped 


TRACHEOTOMY.  479 

by  the  thin  expansion  of  the  cutaneous  colli.  In  this  middle  third 
of  the  neck,  the  cartilaginous  rings  of  the  trachea,  with  the  liga- 
ments between  which  unite  them,  are  readily  identified. 

The  indications  of  tracheotomy,  which  are  quite  numerous, 
are  enumerated  by  Zundel,  under  five  principal  heads  :  1st,  when 
an  obstacle  exists  which  interferes  with  the  free  access  of  air  to 
the  lung,  as  in  case  of  contraction  or  obstruction  of  any  portion  of 
the  air  passages,  including  all  the  diseases  of  the  upper  part  of  the 
respiratory  tract,  and  acting  directly,  such  as  acute  larj-ngitis, 
oedema  of  the  glottis,  and  polypi  or  paralysis  of  the  larynx ;  or  to- 
gether with  those  which  act  indirectly,  as  strangles,  pm-ulent  col- 
lections in  the  guttural  pouches,  anasarca  and  pui-pura  hemon-ha- 
gica  ;  2d,  when  foreign  bodies  have  become  lodged  in  the  fauces  or 
the  larynx,  in  order  to  facilitate  their  extraction,  either  du-ectly,  by 
means  of  special  forceps,  or  indirectly,  by  pushing  them  back  into 
the  mouth  to  enable  the  surgeon  to  grasp  them  with  his  hand  ;  3d, 
to  remove  tumors,  polypi,  cysts  or  cancerous  growths  ;  4th,  in  cases 
of  fractures  of  the  bones  of  the  face,  of  the  cartilages  of  the  larjTix, 
or  of  the  trachea ;  and  5th,  again,  when  the  trachea  has  become 
the  seat  of  any  specific  lesions,  such  as  tracheocele ;  caries  of  the 
tracheal  cartilages,  or  of  deformities,  such  as  may  result  from  frac- 
tures, ossifications  and  contractions. 

The  operation  is,  however,  contra-indicated  when  the  cause  or 
object  which  impedes  respiration  occupies  a  point  so  low  in  the 
passage  as  to  be  beyond  reach  by  the  tracheotomy  tube  ;  or  when 
the  difficulty  in  breathing  and  the  danger  of  suifocation  are  due 
to  a  diseased  condition,  either  of  the  lungs  or  of  the  heart. 

The  instruments  required  for  the  operation  are :  a  pair  of 
curved  scissors,  a  convex  and  a  pointed  bistoury,  a  sharp-pointed 
tenaculum,  a  bull-dog  forceps,  two  blunt  tenaculums  and  a  trach 
eotomy  tube.  Some  special  instruments  for  the  division  and  am- 
putation of  the  trachea  have  been  invented,  but  the  tracheotomes 
as  they  are  called,  do  not  generally  serve  as  good  a  purpose  as  the 
ordinary  instruments  already  named. 

Tracheotomy  tubes  are  of  various  forms  and  devices.  Some 
are  of  very  simple  construction,  and  others  are  more  or  less  com. 
phcated.  The  ordinary  tube  consists  of  a  bent  and  curved  can- 
ula,  made  of  various  diameters,  more  or  less  cylindrical,  and 
secured  on  a  square  plate,  nearly  flat,  or  with  a  curve  in  order 
to  adapt  it  to  the  convexity  of  the  neck,  and  with  an  eyelet  or 


480         OPERATIONS  ON  THE  KESPIEATORY  APPARATUS. 


Fig.  421.— Ordinary  Tracheotomy  Tube,  front  and  back  view. 


slit  at  each  corner,  for  the  attachment  of  bands  or  straps.  These 
tubes  are  generally  made  of  silver  or  nickel-plated  metal,  though 
gutta  percha  is  the  material  sometimes  used,  its  lack  of  solidity, 
however,  rendering  the  instruments  composed  of  it  uncertain  and 
dangerous.  Besides  this  ordinary  tube,  there  is  a  long  catalogue 
of  others,  among  which  we  have  those  invented  by  Dieterichs, 
Gowing,  Spooner,  Vachette,  Pradat,  Brogniez,  Leblanc,  Kenault, 
Peuch,  Imlin,  Trasbot,  and  these  do  not  exhaust  the  list.  But 
among  all  this  host  of  instruments  of  this  class  there  is  probably 
none  w^hich  fulfils  its  purjDose  better  than  that  of  Director  Degives, 
somewhat  modified  by  Professor  Peuch  (Fig.  430),  which,  by  its 
simplicity,  and  especially  from  the  fact  of  its  being  a  self-holder, 
has  proved  itself  to  be  the  most  convenient  of  all  for  general  prac- 
tice. "When  once  inserted  and  adjusted,  this  tube  may  be  left  in 
place  without  danger  of  removal  or  dropping  of  itself,  while  the  or- 
dinary tube,  which  requires  to  be  secured  by  strings  tied  over  the 
neck,  can  never  be  as  safe  as  the  self-retaining  instruments,  which 
hold  themselves. 

There  are  two  methods  of  performing  the  operation,  one  of  which 
may  be  called  the  classical,  and  the  other  the  immediate  method. 
In  the  former,  two  adjoining  tracheal  rings  are  divided,  and  re- 
moved, in  part  or  totally  ;  in  the  latter,  a  longitudinal  incision  is 
made  through  the  rings  without  loss  of  substance  (Fig.  433).     In 


TRACHEOTOMY. 


481 


Fig,  422.— Tube  of  Dieterichs; 
posterior  view. 


Fig.  423.— Qowing's  Tracheotomy  Tube. 


Fig.  424.— Spooner'B  Traclieotomy  Tube. 

either  case  the  animal  is,  if  possible,  kept  on  his  feet,  with  the  head 
elevated  by  a  twitch  apphed  on  the  lower  lip.  It  may  sometimes 
be  necessary  to  place  him  in  stocks ;  to  hobble  his  fore  legs,  or 
perhaps  only  to  raise  one  of  the  fore  feet.  In  some  instances  the 
patient  is  unable  to  stand,  and,  in  fact,  is  already  down  when  the 
surgeon  is  called,  and  this  is  probably  one  of  the  only  conditions 
when  the  longitudinal  incision  is  fully  justified. 

Classical  Method. — This  includes  three   steps,  the   object  of 


■482  OPERATIONS    ON    THE   RESPIRATOKY   APPARATUS. 


Fig.  425.— Vachette's  Tube. 


Fig.  426. -Tube  of  Pradat, 


Fig.  427.— Tube  of  Brogniez. 


the  first  being  the  the  exposure  of  the  trachea ;  of  the  second,  to 
open  it  by  removing  a  circular  portion  of  the  organ  ;  and  the 
third  by  the  introduction  of  the  tube  into  the  aperture  prepared 
for  it. 


TKACHEOTOMY. 


483 


Fig.  430.— Tube  of  Peuch. 

The  operator  stands  facing  the  animal,  slightly  on  the  right. 
Grasping  the  trachea  (the  hair  having  been  closely  cHpped),  he 
fixes  and  stretches  the  skin  with  the  left  thumb  and  fore  finger,  at 
about  the  middle  of  the  tracheal  region,  and  incises  it  with  a  sin- 
gle stroke  of  the  convex  bistoury,  cutting  through  the  skin  and 
the  cutaneous  muscle.  The  incision  is  about  three  inches  in 
length,  and  exposes  the  sterno-hyoideus  and  thyroideus  muscles. 
These  must  be  carefully  isolated  from  the  face  of  the  trachea  by 


484         OPERATIONS  ON  THE  EESPIKATORY  APPARATUS. 


Fio.  433.— Trachea,  open  for  the  introduction  of  the  Tube. 


TKACHEOTOMY.  485 

tlie  dissection  of  the  cellular  tissue  which  confines  them,  and  drawn 
apart  by  means  of  two  blunt  tenaculums,  leaving  a  gaping  wound 
through  which  to  reach  the  trachea,  which  is  thus  exposed,  and 
in  readiness  for  the  second  step  of  the  process. 

Second  Step. — In  the  second  step  portions  of  the  two  cartilages 
which  have  been  selected,  are  held  by  the  pointed  tenactdum,  passed 
through  the  connecting  ligament,  are  excised,  and  a  circular  open- 
ing established  by  the  removal  of  a  semilunar  segment  from  each 
ring.  It  is  necessary  at  this  point  to  be  certain  that  the  isolated 
valve  is  securely  held,  to  guard  against  the  force  of  suction,  by 
which  it  may  be  liable  to  be  drawn  into  the  trachea  as  the  new 
breathing  place  is  suddenly  opened. 

lliird  Step. — This  consists  in  the  insertion  of  the  tube  into 
the  apertiu'e  prepared  for  it,  and  is  the  simplest  and  easiest  part 
of  the  procedure.  The  only  difficulty  likely  to  occur  is  from  the 
neglect  or  error  of  the  operator  in  measuring  the  dimensions  of 
the  opening,  and  securing  a  perfect  coaptation  between  that  and 
the  tube.  If  the  opening  proves  to  be  too  narrow,  it  must,  of 
coui'se,  be  enlarged,  with  the  caution  before  mentioned  against 
losing  any  detached  portions  by  the  suction  of  the  trachea.  The 
bull-dog  forceps  is  of  value  here.  If  the  tube  is  of  the  self-hold- 
ing kind,  its  introduction  completes  the  operation  ;  but  if  the  or- 
dinary tube  before  described  is  used,  the  t}Txig  over  the  neck  of 
the  tapes  attached  to  the  flat  plate  becomes  the  final  manipulation. 
If  no  tube  is  at  hand,  the  wound  must  be  held  apart  with  tapes 
applied  upon  its  edges,  and  tied  over  the  neck. 

Immediate  Operation  by  Longitudinal  Incision.  —  This  is 
done  with  the  sharp  straight  bistoury,  passing  it  at  once  through 
all  the  tissues,  penetrating  the  trachea  between  two  cartilages, 
and  making  a  vertical  incision  of  two  or  three  rings.  This  mode, 
as  we  have  said,  is  principally  justifiable  in  case  of  emergency 
when  suffocation  is  imminent,  and  no  time  can  be  lost  in  proour- 
ing  the  instruments  necessary  for  the  classical  operation. 

There  is  still  another  mode  of  operating,  credited  to  Kris- 
haber,  which,  from  the  location  where  it  is  performed,  is  better 
known  as  sub-cricoidean  tracheotomy,  and  which  consists  in  mak- 
ing the  opening  through  the  crico-tracheal  ligament,  which  unites 
the  cricoid  cartilage  to  the  first  tracheal  ring.  It  includes  three 
steps,  comprising  the  incision  of  the  skin  and  dissection  of  the 
underl^dng  muscles,  the  incision  of  the  ligament,  and  the  inser 


486         OPERATIONS  ON  THE  RESPIRATORY  APPARATUS. 

tion  of  the  tube.  This  mode  of  operating  is  simple  and  of  easy- 
performance,  especially  in  the  absence  of  any  swelling  of  the  re- 
gion. It  prevents  perichondi'itis,  and  is  not  followed  by  changes 
in  the  diameter  of  the  trachea.  It  has,  besides,  the  advantage 
of  allowing  the  tube  to  be,  to  a  great  extent,  concealed,  and 
thus  removes  one  of  the  principal  objections  urged  against  the 
operation  in  cases  of  chronic  roaring,  for  which  it  might  well  be 
recommended. 

The  subsequent  measures  vary  somewhat,  depending  upon 
whether  the  operation  has  been  performed  as  only  a  temporary 
expedient,  or  as  a  permanent  means  of  rehef  for  the  difficulty  in 
breathing.  In  the  first  case,  it  is  not  neisessary  to  remove  the 
tube  before  the  acute  symptoms,  which  have  required  its  intro- 
duction, have  subsided,  which  is  a  condition  which  generally  does 
not  continue  more  than  two  or  three  days.  If,  however,  during 
that  time  the  canula  of  the  tube  should  become  closed  by  the  dis- 
charge or  other  pathological  secretions,  it  must  be  removed, 
cleansed  and  rej)laced,  to  be  left  until  its  use  becomes  unneces- 
sary, which  will  be  readily  discovered  by  the  restored  regularity 
of  the  respiration  when  the  tube  is  removed  or  its  canula  becomes 
occluded. 

If  the  tube  is  to  be  worn  permanently,  careful  attention  should 
be  paid  to  its  proper  fit  and  adjustment,  and  its  daily  removal 
and  thorough  cleansing  shoiild  never  be  overlooked.  It  should 
be  ascertained  that  the  instrument  fits  properly,  being  held  with 
sufficient  firmness  in  the  opening,  and  making  a  safe  and  moder- 
ate pressure  on  the  soft  tissues  around.  "When  the  instrument 
has  been  worn  for  a  (variable)  time,  the  ojDening  of  the  trachea 
has  a  tendency  to  contract,  and  becomes  smaller  by  reason  of  the 
development  of  the  granulation  of  the  edges  of  the  wound.  In 
this  case  it  may  become  necessaiy  to  enlarge  the  opening,  by  the 
excision  of  the  granulations,  sufficiently  to  allow  of  the  ready  re- 
introduction  of  the  tube.  When  it  becomes  desirable  to  close  the 
wound,  the  removal  of  the  tube,  and  the  application  of  an  ordi- 
nary dressing,  protecting  it  only  by  a  pad  of  antisej)tic  oakum, 
kept  in  place  by  a  few  turns  of  bandage  around  the  neck,  is  all 
that  is  necessary.  Usually,  after  two  or  three  weeks  the  cicatrix 
is  complete. 

The  oi^eration  of  tracheotomy  may  be  accompanied  or  followed 
by  various  accidents  : 


TEACHEOTOMY.  487 

ITemorrhage  is  rare,  the  small  amount  of  bleeding  wliicli 
occurs  proceeding  from  the  division  of  some  of  the  arterioles, 
branches  of  the  carotid,  passing  between  the  cartilages  over  the 
sui-face  of  the  inter-cartilaginous  Hgament.  It  ceases  spontane- 
ously, and  never  requu-es  any  special  attention. 

Emphysema  of  the  neck  may  take  place  when  the  cellular  tis- 
sue is  very  loose  and  the  edges  of  the  skin  overlap  the  tracheal  in- 
cision. It  generally  subsides  without  interference,  or  by  moder- 
ate, regvdated  pressure. 

Tracheocele. — Renault  so  denominates  certain  growths  which 
appear  on  the  tracheal  mucous  membrane,  as  the  result  of  the  ir- 
ritation produced  by  the  friction  of  the  branches  of  the  tube  which 
come  in  contact  with  it.  He  claims  to  have  noticed  their  appear- 
ance six  weeks  after  the  removal  of  the  instrument.  The  nature 
of  the  tumor  varies  much.  They  may  be  purulent,  but  they  are 
more  commonly  fibrous  and  of  slow  growth;  and  may  sometimes 
take  the  character  of  ossification  of  the  cartUages.  If  these  ob- 
structions appear  above  the  seat  of  the  operation,  the  trouble  is 
easily  remedied  by  the  reintroduction  of  the  tube,  but  if,  how- 
ever, they  are  found  below  that  point,  it  is  a  more  serious  com- 
plication, since  it  requires  a  second  operation  at  a  point  below 
that  of  the  first. 

The  ohstruction  of  the  trachea  by  plastic  exudation  above  and 
below  the  seat  of  the  operation,  or  its  contraction,  caused  by  the 
overlapping  of  the  divided  ends  of  the  rings  which  may  have  been 
incised,  may  also  be  met  with,  and  can  only,  as  in  the  former  case, 
be  overcome  by  a  second  operation.  We  personally  remember  a 
case  in  which  the  formation  of  a  post-tracheal  abscess,  which  had 
produced  extensive  contraction  in  the  calibre  of  the  trachea, 
proved  fatal  through  the  impossibility  of  the  introduction  of  a 
tube  after  a  second  operation.  The  patient  had  been  treated  sev- 
eral weeks  previously  for  an  attack  of  strangles,  which  had  re- 
quired an  operation,  and  some  six  weeks  after  his  recovery  was 
brought  back  suffering  with  a  severe  attack  of  roaring.  As  he 
entered  our  hospital  he  fell  to  the  ground,  and  the  second  opera- 
tion was  rapidly  performed  by  a  longitudinal  incision,  but  the 
tubes  we  had  at  hand  were  all  too  large,  and  in  a  few  moments 
the  animal  died.  At  the  post-mortem  a  large  abscess  was  found 
behind  the  trachea,  just  opposite  the  seat  of  the  first  operation, 
and  the  pus  in  collecting  had  so  compressed  and  deformed  the 


4bb         OPERATIONS  ON  THE  KESPIEATORY  APPARATUS. 

trachea  that  the  index  finger  could  scarcely  be  inserted  into  the 
passage. 

THOKACENTESIS. 

The  usual  intention  of  this  operation  is  the  removal  from  the 
thoracic  cavity  of  suppurative  matter  {empyema)  or  blood  or  se- 
rous fluid,  by  puncturing  the  walls  of  the  chest.  It  is  indicated 
in  hydrothorax  and  in  some  traumatisms  of  the  chest,  and  when- 
ever there  is  a  large  collection  of  bloody  or  other  fluid  in  the  thorax; 
in  all  cases,  in  fact,  where  the  ordinary  forms  of  treatment  have 
failed  to  relieve  the  patient  thus  affected.  Although  extensively 
performed  in  human  surgery,  w^here  the  advantages  and  facilities 
of  operating  are  so  many  and  so  manifest,  it  has  naturally  proved 
less  beneficial  to  veterinary  patients.  And  still,  though  probably 
in  the  majority  of  the  cases  in  which  it  has  been  employed  the 
rehef  which  has  followed  it  has  been  of  only  a  temporary  charao- 
'  ter,  and  served  only  to  prolong  briefly  the  life  of  the  animal  sub- 
jected to  it,  some  few  cases  are  on  record  in  which  it  has  given 
very  excellent  results.  The  researches  of  St.  Cyr  have,  moreover, 
demonstrated  that  the  operation  is  perfectly  harmless,  contrary  to 
the  opinion  formerly  held,  and  that  a  large  proportion  of  its  fail- 
ures to  effect  recovery  are  due  to  the  fact  that  its  application  had 
been  too  long  postponed  to  justify  a  reasonable  expectation  of 
success ;  when,  in  fact,  it  had  been  deferred  imtil  the  accumula- 
tion of  fluid  had  already  become  too  abundant,  and  the  pleural 
membranes  had  already  assumed  the  condition  of  a  tendency  to 
pyogeny. 

On  this  point,  Peuch  and  Toussaint  remark  that  if  the  punc- 
ture is  made  when  only  the  lower  thii'd  of  the  cavity  is  full,  and 
if  after  the  evacuation  of  the  hquid  a  diluted  solution  of  tincture 
of  iodine  is  injected  into  the  pleural  sac,  as  is  done  in  human 
surgery,  perhaps  more  satisfactory  residts  might  be  realized. 
Our  own  -view,  however,  is  that  the  disposition  of  the  pleura  and 
of  the  ca\dties,  which  they  form,  would  scarcely  justify  the  in- 
jection. 

The  instruments  required  are  a  straight  or  convex  bistomy, 
and  a  small  trocar,  straight  or  slightly  curved.  Keul  has  invented 
a  paracento-injector  trocar  (Fig.  434),  which  is  used  for  both  the 
puncture  and  the  subsequent  injection  of  the  medical  compounds. 
The  use  of  the  aspirator  (Dieulafoy)  is  also  recommended. 


THORACENTESIS. 


489 


Fig.  434.— Trocar  paracento-injecteur  de  Keul. 


According  to  St.  Cyr,  the  proper 
place  for  the  puncture  is  between  the 
seventh  and  eighth  sternal  ribs,  a 
little  above  the  spur  vein,  this  jDoint 
permitting  the  removal  of  a  larger 
quantity  of  fluid  than  any  other,  with 
the  advantage  also  of  offering  a  wider 
space  between  the  ribs,  and  a  dimin- 
ished thickness  in  the  muscular  sub- 
stance. Unless  there  are  special  rea- 
sons to  the  contrary,  the  puncture  is 
made  on  the  right  side ;  if  operating 
on  the  left  is  indicated,  care  must 
be  taken  to  avoid  injuiing  the  heart. 
For  this  reason  the  puncture  is  made 
between  the 
eighth  and  ninth 
ribs,  with  the 
point  of  the  in- 
strument turned 
backward.  The  puncture  is  made  with  the  patient  on  his  feet, 
and  he  rarely  needs  any  apparatus  of  restraint,  though  it  will 
always  be  judicious  to  apply  a  twitch  on  his  lip. 

St.  Cyr  describes  the  operation  as  follows  :  "  The  operator 
makes  an  incision  with  the  bistoury,  about  one  inch  long,  near 
the  anterior  border  of  the  eighth  rib  or  of  the  ninth,  if  he  is  on 
the  left  side,  dividing  the  skin  and  superficial  muscular  layers 
until  he  reaches  the  internal  intercostal  muscle,  which  he  leaves 
intact.  In  piercing  the  cavity,  he  holds  the  trocar  with  the  right 
hand,  guarding  against  its  entering  the  chest  too  deeply  by  keep- 
ing his  fingers  sufficiently  near  the  point  to  gauge  and  control  its 
depth  through  the  remaining  undivided  muscle.  What  remains 
then  is  to  withdraw  the  rod  from  the  trocar,  and  keep  the  latter 
in  place  while  the  fluid  escapes.  Any  albumino-fibroid  clots, 
which  may  enter  the  canula  and  obstruct  the  flow  of  the  liqiiid, 
may  be  dislodged  by  introducing  a  blunt  stylet  into  the  tube. 
When  the  canula  is  withdrawn  after  the  escape  of  a  sufficient 
amount  of  fluid,  the  wound  is  closed  with  a  single  pin  suture. 

The  trocar  of  Mr.  Keul  is  inserted  (Figure  434)  in  the  usual 
manner,  with  the  nut  E  closed,  and  after  removing  the  desired 


490         OPEBATIONS  ON  THE  KESPIEATOKY  APPARATUS. 

quantity  of  fluid,  the  nut  F  is  closed  and  E  is  opened.  In  the 
funnel  D,  the  diluted  tincture  of  iodine  is  j)oured  and  carried  into 
the  chest  as  slowly  as  the  operator  thinks  proper,  where  it  mixes 
with  the  remaiaing  portion  of  the  fluid.  "When  the  injection  re- 
turns in  the  instrument  to  a  level  with  the  little  piece  of  glass  C, 
the  nut  E  is  closed,  and  the  instrument  removed,  thus  guarding- 
entirely  against  the  introduction  of  air  into  the  chest. 

In  resi^ect  to  the  quantity  of  fluid  that  can  be  safely  removed 
at  once,  there  are  varying  opinions.  Some  practitioners  hold  that 
the  cavity  ought  to  be  entirely  emj)tied,  or,  at  least,  so  far  as  the 
location  of  the  punctiu'e  allows,  while  others  favor  the  method  of 
discharging  the  contents  by  installments. 

According  to  St.  Cjr,  who  has  exj^erimented  very  extensively 
in  this  matter,  the  removal  of  a  small  quantity  is  followed  by  a 
negative  result,  the  fluid  forming  again  in  a  very  short  time ;  while, 
on  the  other  hand,  if  the  entire  accumulation  is  taken  away  at  one 
time,  amounting,  perhaj)s,  to  forty  or  fifty  quarts,  it  must  be  at 
the  hazard  of  encountering,  as  supervening  disorders,  syncope, 
rupture  of  the  j^ulmonary  vesicles,  congestions,  or  splenic  or  hep- 
atic hemorrhages,  with  an  ultimate  fatal  termination. 

The  question  thus  remains  unsolved,  and  if  recoveries  have 
been  recorded  by  Lafosse,  Jr.,  Strauss,  Massot,  Bar  and  others, 
failures  have  followed  the  operation  in  the  hands  of  Gohier, 
Pilger,  Bassi,  Dieterichs,  Prudhomme,  St.  Cyr,  etc.  Pelle  and 
Sewell  have  obtained  recoveries  when  removing  all  the  fluid  at 
once.  Our  own  experience  has  been  negative  in  the  cases  in  which 
we  have  observed  both  conditions — that  of  partial,  and,  as  weU, 
that  of  the  entire  removal  of  the  fluid. 

Supplementing  the  operation  with  medicinal  injections  of 
some  sort  has  been  recommended.  Hertwig  has  used  astringent 
solutions ;  Leblanc,  Bouley  and  Prudhomme  have  favored  the  use 
of  tincture  of  iodine,  and  the  following  prescriptions,  used  in 
human  surgery,  are  recommended  by  Peuch  and  Toussaint : 

Weak  Solution — 3 — Tinct.  of  iodine,  10  parts;  iodide  of 
potass.,  1  part ;  distilled  water,  100  parts. 

This  is  first  used,  but,  if  it  fails,  the  following  is  injected  : 

Strong  Solution — 5 — Tinct.  of  iodine,  30  parts;  iodide  of 
potass.,  4  parts  ;  distilled  water,  100  parts. 

The  general  treatment  recommended  for  those  foi'ms  of  dis- 
eases in  which  these  hqoid  accumulations  originate,  must  be  per- 


THORACENTESIS. 


491 


severed  in  after  the  thoracentesis,  inchiding  the  counter-irrita- 
tions, diuretics,  tonics,  stimulants,  alteratives,  etc. 

The  operation  is  performed  on  the  dog  also  in  the  same  man- 
ner as  on  the  horse,  but  either  with  smaller  trocars,  or,  what  is 
better,  with  some  one  of  the  aspirators  recently  invented. 

With  this  animal  the  results  are  more  satisfactory  on  account 
of  the  simplicity  and  unilateral  development  of  the  pleuritic 
effusion. 


CHAPTER  X. 

OPERATIONS    ON   THE  CIRCULATORY 
SYSTEM. 

BLEEDING— VENESECTION. 

The  term  bleeding,  or  venesection,  signifies  the  opening  of 
certain  veins  for  the  escape  of  a  portion  of  the  blood,  for  a  ther- 
apeutical, or  experimental  pm-pose.  If  it  is  designed  to  reduce 
the  volume  of  the  circulation,  it  is  known  as  general,  and  is  per- 
formed upon  some  one  of  the  larger  blood  vessels ;  if  practiced 
to  remove  blood  only  from  a  given  region,  it  becomes  local,  and 
in  that  case  the  smaller  vessels  are  divided.  A  better  division  is 
that  which  is  based  on  the  nature  of  the  vessel  which  is  opened, 
and  thus  it  is  phlehotomy,  if  a  vein  is  opened;  arteriotomy,  if 
an  artery ;  and  capillary,  or  arterio-j^hlebotomy ,  when  the  opera- 
tion is  practiced  upon  the  capillary  system. 

There  has  been  much  discussion  upon  the  question  of  the 
utility  of  blood-letting,  and  strong  advocates  and  earnest  opj)0- 
nents,  who  have  argued  its  benefits  and  denied  its  usefulness,  and, 
in  fact,  ascribed  evil  results  to  its  practice,  whether  the  depletion 
affects  the  general  circulation  or  a  limited  region.  But  upon  this 
we  shall  not  enter.  Those  who  maintain  its  practice  consider  it 
to  be  indicated  when  it  is  desirable  to  reduce  the  activity  of  the 
circulation,  or,  on  the  contrary,  to  stimulate  it  in  parts  where, 
from  different  causes,  it  has  been  temporarily  suspended,  and  to 
stimulate  absorption,  or  to  relieve  the  organism  of  foreign  ele- 
ments. 

It  is,  however,  contra-indicated  in  aU  eruj)tive  fevers,  in  anaemic 
patients,  and  in  those  suffering  with  typhoid  diseases. 

The  old  fashion  of  "  taking  blood"  as  a  projohylactic  measure, 
or  at  a  certain  season  of  the  year,  is  simply  the  result  of  an  ignor- 
ant delusion. 

The  quantity  of  blood  that  can  be  removed  must  vary,  of 
course,  with  the  size,  the  nature  and  the  condition  of  the  animal. 


PHLEBOTOMY. 


493 


Gourdon  recommends  the  following-  scale  as  representing  the  aver- 
age bleeding,  proper,  for  the  animals  named  : 

The  horse,  between  4  and  5  pounds ;  large  ruminants,  5  to  6 
pounds ;  pig,  1  to  1^  pounds ;  sheep,  6  to  9  ounces ;  dog,  3  to  6 
ounces. 

PHLEBOTOIilY. 

Fhlebotomy,  or  the  opening  of  veins,  is  the  mode  universally 
adopted  for  general  bleeding,  and  is  generally  performed  upon 
superficial  veins. 

The  instruments  necessary  are  fleams,  lancets,  scissors,  bleed- 
ing-sticks, pins,  pin-holders,  graduated  jars  or  vases,  and  a  piece 
of  silk,  and,  for  small  animals,  bandages. 

The  fleam,  made  in  various  forms,  resembles  a  small  lancet, 
and  is  secured  on  a  steel  support  received  into  a  metaUic,  horn  or 
gutta-percha  handle.     Ordinarily,  two  or  three  lancets  of  different 


Fig.  435.— Ordinary  Fleam,  with  three  blades. 

sizes  have  one  common  handle,  upon  which  they  are  so  mounted 
as  to  be  used  singly  with  facility. 

Some  of  them,  of  German  make,  or  of  English  invention,  or 
of  a  Belgian  pattern,  act  with  a  spring,  like  the  phlebotome  of 
Brogniez. 

The  hleedlnrj -stick  is  simply  a  stick  of  hard  and  hea^y  wood,  a 
foot  or  more  in  length,  with  which  to  drive  the  fleam  into  the 
vein. 


494 


OPERATIONS    ON    THE    CIRCULATORY    SYSTEM. 


Fig.  436.  Fig.  437. 

Figs.  436,  437, 438.— German  and  English  Spring  Fleams. 


riG.  439.— Fleam  of  Brogniez. 


FIG.  440.— Bleeding  Stick. 


PHLEBOTOMY. 


495 


The  graduated  vase  is  to  receive  the  blood,  and  at  the  same 
time  measure  its  flow.     In  ordinary  practice  a  pail  is  substituted. 

The  2^ms  must  be  long-  and  strong.  The  pin-holder  is  used  to 
assist  in  the  introduction  of  the  pin  Avhen  the  suture  is  made  and 
the  bleeding  terminated. 

Sponges  and  cold  water  should  be  accessible. 

Modus   Opekandi. 

Position  of  the  Animal. — The  standing  position  is  the  one 
generally  preserved.  The  animal  is  held  well  in  hand  by  an  as- 
sistant, and  if  he  appears  to  be  excited  and  unwilhng  to  stand 
quietly,  and  soothing  treatment  has  no  effect,  a  twitch  is  placed 
on  his  nose,  or  a  cap  on  his  head. 

The  operation  consists  of  three  steps: 
1st.  Preparation  of  the  Plood  Vessel : 
This  consists  in  a];)j)ly^g'  sufficient  pres- 
sure upon  it  to  temporarily  interrupt 
the  circulation  and  cause  it  to  become 
more  prominent  under  the  skin.  This 
is  done  with  the  fingers,  and  some- 
times AVith  a  ligature,  when  the  loca- 
tion of  the  vessel  permits  it.  In  some 
blooded  and  thin-skinned  animals,  a 
little  brisk  exercise  is  sufficient  to  stim- 
ulate the  circulation  and  render  the 
veins  prominent. 

2d.  02)ening  of  the  Vessel. — This 
is  done  with  the  fleam,  the  lancet  or 
the  bislomy.  The  fleam  is  more  com- 
monly used  for  large  animals.  Held  as 
in  figure  441,  it  is  brought  opposite  the 
vessel,  parallel  to  its  course,  and  per- 
fectly perpendicular  to  it,  and  at  such 
a  distance  from  the  skin  as  to  apjjrox- 
imate  very  nearly,  but  without  forming 
an  actual  contact  with  it.  When  in 
this  position  the  fleam  is  made  to  pen- 
etrate the  vessel  by  a  smart  blow  with 
the  bleeding-stick  on  the  back  of  the 


Fig.  441.— Manner  of  Holding  the 
Fleam. 


blade;    some  practitioners,  instead  of 


496  OPERATIONS    ON    THE    CIRCULATORY    SYSTEM. 

striking  with  the  stick,  apply  the  blow  with  their  hands,  hut 
with  cattle,  the  stick  is  indispensable.  The  moment  the  blow 
has  been  appHed  properly,  the  stream  of  blood  escapes  freely; 
when  the  blow  has  been  too  Hght,  and  the  skin  only  divided,  with 
but  a  scanty  or  no  escape  of  the  blood,  it  is  called  a  v:/dte .  bleed- 
ing ;  and  slahhery  when  the  opening  is  not  large  enough  for  the 
escape  of  a  full  stream,  or  when  the  openings  of  the  vein  and  of 
the  skin  are  not  in  apposition,  which  will  be  the  case  if  the  fleam, 
instead  of  being  held  perfectly  perpendicular  to  the  skin,  has 
been  held  obhquely.  The  opening  of  the  blood  vessel  with  the 
spring  fleam  is  performed  in  the  same  manner,  except  that  the 
lancet  receives  its  impulse  from  the  spring  instead  of  the  stick. 
The  puncture  with  the  lancet  or  bistoury  should  be  made  with  a 
single  stroke  of  the  instrument.  In  large  and  superficial  veins, 
the  spring  lancet  is  as  easily  and  safely  managed  as  the  fleam. 

3d.  Closing  the  Blood  Vessels  and  jStojyjnng  the  Floio. — 
"When  a  sufficient  quantity  of  blood  has  been  drawn,  and  the  j)res- 
sure  upon  the  vein,  which  has  been  continued  during  the  flow,  is 
gradually  relaxed,  the  stream  ceases,  more  or  less  completely.  To 
terminate  it  entirely,  a  simple  stitch  of  pin  sutm-e  is  api^lied.  It 
is  to  be  prefeiTcd  to  all  other  means,  such  as  pressm-e,  bandaging 
or  adhesive  plasters.  The  suture  is  made  by  grasj)ing  the  two 
edges  of  the  skin  with  the  thumb  and  index  finger  of  one  hand, 
and  sHghtly  raising  them,  then  transfixing  them  with  a  long  pin 
through  their  middle,  with  either  the  hand  or  the  pin-holder,  in- 
cluding a  fair  amount  of  skin,  and  comjDleting  it  by  a  special  knot, 
made  with  silk  or  a  loop  of  the  long  hair  of  the 
mane  or  tail  of  the  animal.  In  aj^plpng  this 
suture,  the  skin  must  not  be  pulled  away  from 
the  body  too  far,  nor  the  knot  tied  excessively 
tight.  To  keep  the  wound  clean  and  prevent 
Fig.  442.— Suture  after  the  animal  from  rubbing  off  the  dressings  is  aU 
mg.  ^^^  ^^  necessary,  for  a  few  hours,  after  the 

operation.  The  wound  heals  by  first  intention,  and  the  suture  and 
the  pin  can  be  safely  removed  after  twenty-fom'  hours. 

Phlebotomy  in  Solipeds.. 

Four  of  the  principal  superficial  veins  are  selected  for  this 
operation  in  soHpeds  ;  the  jugular,  the  cephalic,  the  subcutaneous 
thoracic  and  the  internal  saphena. 


PHLEBOTOMY. 


497 


Phlebotomy  at  the  Jugular. 


This  vein  is  usually  selected  on  accoimt  of  its  size,  its  situation, 
and  the  facility  with  which  it  can  be  opened,  and  the  wound  of 
the  skin  closed.  It  is,  however,  contra-indicated  when  the  vessel 
is  in  any  degree  diseased,  or  when  the  animal  is  suffering  with 
itching  skin  diseases. 

Formed  by  the  superficial  temporal  trunk  and  the  internal 
maxillary  vein,  the  jugular  descends  through  the  parotid  gland  to- 
ward its  inferior  extremity,  receiving  several  collateral  veins,  and 
reaches  the  groove  of  the  lower  part  of  the  neck,  which  from  its 
presence  is  called  the  jugular  groove^  until  it  reaches  the  lower 
extremity  of  the  neck,  when  it  enters  the  chest.'  In  its  course  in 
the  groove  it  accompanies  more  or  less  closely  the  carotid  artery, 


Fig.  443.— Anatomy  of  the  Jugular  Vein  and  (Esophagus  in  the  Horse.  J  J,  Jugular 
vein;  C,  carotid  artery;  O  11,  omo-hyoideus  muscle;  D,  oesophagus;  S,  sterno-maxillariB 
muscle;  M,  mastoido-humeralis  muscle. 


498  OPEEATIONS    ON    THE    CIKCULATOKY    SYSTEM. 

but  in  the  middle  third  of  its  length  becomes  separated  from  it  bj 
the  flat  ribbon-like  structure  of  the  sub-scapulo  or  omo-hyoideus, 
whose  fibres  pass  obliquely  between  the  two  blood  vessels,  from 
below  upward.  It  is,  therefore,  in  the  middle  third  of  the  neck 
that  the  bleeding  at  the  jugular  must  be  made,  in  order  to  avoid 
wounding  the  carotid  artery. 

Besides  the  general  rules  already  stated,  this  special  bleeding 
requires  peculiar  measures. 

(a)  Position  of  the  Animal. — He  must  be  kept  well  in  hand, 
with  the  head  somewhat  elevated,  and  must  be  prevented  from 
seeing  the  various  movements  of  the  operator,  by  covering  his 
head  with  the  cap  or  mask,  or  by  having  the  eye,  on  the  side  of  the 
operator,  covered  with  the  hand  of  an  assistant. 

{b)  The  fleam  is  generally  employed,  the  size  of  the  blade  vary- 
ing according  to  the  thickness  of  the  skin  and  the  condition  of  the 
blood  vessels.  The  left  jugular  is  generally  selected,  unless  contra- 
indicated  for  some  special  reasons. 

(c)  Preparation  of  the  J^ein.  —  The  application  of  artificial 
pressure  for  the  dilatation  of  the  vein  is  not  only  unnecessary  in 
solipeds,  but  has  in  some  cases  proved  dangerous.  In  this  step  of 
the  operation  the  hand  is  to  be  preferred  as  safer  and  more  reli- 
able than  any  ligature  or  bandage  can  possibly  be. 

The  compression  is  made  with  the  fingers  of  the  hand  which 
holds  the  fleam,  applying  it  in  the  jugular  groove,  below  the  point 
where  the  incision  is  to  be  made.  The  projection  of  the  vein  may 
be  made  more  distinct  by  moistening  the  hair  over  the  spot  to 
be  punctured,  with  a  wet  sponge.  The  improper  habit  to  which 
some  practitioners  are  addicted,  of  doing  this  with  their  saliva,  by 
spitting  upon  the  neck  is  to  be  severely  condemned.  If  the  bleed- 
ing takes  place  on  the  left  side,  the  pressure  must  be  made  with 
the  left  hand,  the  operator  turning  his  back  toward  the  hind  parts 
of  the  animal.  If  it  takes  place  on  the  right  side,  the  pressure  is 
made  with  the  fingers  of  the  right  hand. 

(d)  02yening  of  the  Vein. — Placed  as  we  have  described,  at 
the  side  of  the  neck  of  the  patient,  his  back  turned  toward  his 
hind  parts,  and  pressing  with  the  fingers  of  his  left  hand  which 
holds  the  fleam,  as  before  stated,  the  operator  grasps  the  bleeding- 
stick,  and  striking  upon  the  fleam,  opens  the  vein,  and  the  blood 
escapes  in  a  good,  full  stream.  Maintaining  the  pressure  on  the 
vein  throughout  the  flowing  of  the  blood,  he  lays  aside  the  stick 


PHLEBOTOMY.  499 

and  the  fleam,  and  attends  to  tlie  flow  of  the  blood  into  the  grad- 
uated jar,  or  the  pail  provided  to  receive  it. 

(e)  Keeping  the  Stream. — As  we  have  said,  the  pressure  upon 
the  blood  vessel  must  be  sustained  from  the  beginning  to  the  end 
of  the  operation.  Eeheviug  it  but  for  a  moment  is  an  error, 
likely  to  be  followed  by  the  introduction  of  air  through  the  wound 
into  the  vein.  Not  only  must  it  be  kept  up  continuously,  but  it 
must  be  steady.  The  habit  which  largely  prevails  of  moving  the 
fljigers  or  the  vase  up  and  down  along  the  vein  while  the  pressure 
is  applied,  and  with  the  idea  of  stimulating  the  flow  of  the  blood,  is 
most  dangerous.  If  the  blood  does  not  escape  freely,  though  the 
operation  has  been  properly  performed,  an  increased  circulation 
may  be  stimulated  by  making  the  animal  move  his  jaws,  or  shak- 
ing the  bit  in  his  mouth,  or  placing  the  bleeding-stick  or  a  finger 
of  the  assistant,  into  the  mouth  over  the  bars,  and  quietly  moving 
them. 

(/)  "When  the  bleeding  is  to  be  stopped,  the  operator  applies 
one  of  his  fingers  over  the  wound  of  the  skin  and  gradually  re- 
moves the  pressure  made  below  it.  When  this  has  been  done,  he 
proceeds  to  the  apphcatiou  of  the  suture,  always  introducing  the 
pin  with  the  head  turned  uj^ward,  irrespective  of  the  side  on  which 
the  operation  has  been  performed. 

{g)  Subsequent  Care. — This  is  the  same  as  in  other  cases,  but 
we  may  add  that  an  animal  that  has  been  bled  at  the  jugular  is 
unfit  to  work  for  three  days,  in  order  to  give  time  for  the  wotmd 
to  heal  completely. 

Phlebotomy  at  the  Cephaxic  Vein. 
The  cephaUc  is  one  of  the  terminal  branches  of  the  median 
subcutaneous  vein,  and  runs  upward  and  forward  to  pass  toward 
the  lower  extremity  of  the  coraco-radialis,  where  it  crosses  the 
tendinous  band  which  this  muscle  sends  to  the  anterior  extensor 
of  the  metacarpus,  running  in  the  space  which  separates  the  sterno- 
humerahs  muscle  from  the  levator-humeri,  and  emptying  into  the 
jugular,  a  little  in  front  of  the  confluent  of  those  two  veins.  In 
this  coiu'se,  the  most  accessible  portion  is  that  which  rests  on  the 
inferior  extremity  of  the  levator-humeri.  The  fibrous  band  of  the 
coraco-radialis  is  the  guide  indicating  its  position,  viz.,  a  little  in- 
side the  forearm,  on  a  level  with  the  anterior  and  oblique  fold 
which  separates  the  arm  from  the  forearm. 


500 


OPERATIONS    ON    THE   CIRCULATORY   SYSTEM. 


Fig.  444.— Anatomy  of  the  Cephalic  Vein,  m,  Median  subcutaneous  vein;  b,  basilic 
■vein;  c,  cephalic  vein;  d,  inferior  extremity  of  the  coraco-radialis;  t,  aponeurotic  band 
extending  from  the  coraco-radialis  to  the  anterior  extensor  of  the  metacarpus;  s,  ster- 
no-humeralis;  h.  mastoido-humeralis;  «,  space  between  these  two  muscles;  /,  humeral 
vein. 

On  account  of  the  presence  of  the  other  terminal  branches  of 
the  main  vein,  from  which  the  cephahc  rises,  viz.,  the  basihc,  pres- 
sure upon  the  cephahc  does  not  allow  of  its  dilatation.  To  obtain 
this,  the  animal  must  be  exercised  for  some  time,  and  when 
brought  to  stand  still,  to  raise  the  opposite  leg,  or  to  carry  the 
leg  to  be  bled  forward. 

As  the  vein  is  easily  displaced  from  its  position,  it  is  hardly 


PHLEBOTOMY. 


501 


safe  to  attempt  to  open  it  witli  the  lancet.  The  fleam  is  always 
preferable.  If  the  bleeding  is  from  the  left  vein,  the  instrument 
is  held  with  the  right  hand,  the  operator  is  placed  against  the 
shoulder,  fleam  having  its  blade  turned  downward,  the  fingers 
resting  against  the  chest,  and  with  a  blow  of  the  stick  the  vein  is 
opened.  This  bleeding  is  often  accompanied  by  the  formation  of 
a  hematoma  over  the  course  of  the  vessel,  due  to  the  fact  that 
very  often  the  fleam  has  opened  the  vein  through  and  through. 
This,  however,  is  not  a  matter  of  any  serious  consequence. 

Phlebotomy  on  the  Subcutaneous  Thoeaoic. 

This  vein  rims  on  the  side  of  the  thorax,  on  a  level  with  the 
stemo-trochineus  muscle,  and  is  readily  discovered  toward  the 
sixth  or  seventh  rib.  To  render  it  more  conspicuous,  a  bandage 
can  be  api)Hed  around  the  chest,  as  suggested  by  Chabert,  or  by 
carrying  the  leg  of  the  side  to  be  bled  forward,  and  by  rubbing 
hard  the  tract  of  the  vein,  or  even  by  simple  pressure  with  the 
fingers. 

The  operation  can  be  performed  either  by  a  simple  puncture  with 
a  lancet,  or  with  a  fleam,  held  parallel  with  the  course  of  the  ves- 
sel, and  between  two  ribs,  to  avoid  breaking  the  instrument  against 
one  of  the  bones.  The  bleeding  is  stopped  in  the  usual  way.  It 
is  not  unfrequently  followed  by  the  formation  of  a  thrombus, 
which  generally  disappears  by  pressure,  or  astringent  local  appli- 
cations, and  often  by  spontaneous  absorj)tion. 

Phlebotomy  at  the  Internal  Saphena. 

The  comparatively  large  size  of  this  vein,  and  its  superficial 
position,  both  explain  and  justify  the  fact  that  next  to  the  jugular, 
it  is  the  one  most  commonly  selected  for  the  operation.  Fortius 
reason  phlebotomy  is  indicated  here,  when  it  is  contra-indicated 
upon  the  vein  of  the  neck. 

The  saphena  is  formed  by  two  branches,  and  in  its  course 
crosses  slightly  the  direction  of  the  tibia  in  running  upward  on 
the  surface  of  the  tibial  aponeurosis,  arri\dng  at  the  flat  of  the 
thigh,  formed  by  the  short  adductor  of  the  leg,  and  then  dips  in 
the  space  left  between  this  muscle  and  the  long  adductor,  where 
it  empties  into  the  femoral.  In  this  course  the  vein  is  superficial, 
covered  only  by  a  thin  skin,  from  which  it  is  separated  by  a  thin 
ajjoneurotic  layer.     It  is  at  a  point  where  the  vein  i^asses  over  the 


502 


OPERATIONS   ON    THE    OIKCULATOKY    SYSTEM. 


Fig.  445.— Anatomy  of  the  Internal  Saphena  Vein,  s,  internal  saphena  vein;  e,  its 
anterior  root;  t,  its  posterior  root;  /,  femoral  vein;  g,  deep  inguinal  lymphatic  glands; 
c,  short  adductor  of  the  leg;  I,  long  adductor  of  the  leg;  a,  subcutaneous  aponeurotic 
layer;  r,  fascia  lata. 

flat  of  the  thigh  that  it  must  be  oi^ened.  If  the  operation  is  per- 
formed with  the  fleam,  the  higher  the  better ;  if  with  the  lancet, 
it  can  be  done  as  the  vein  passes  over  the  tibia,  where  it  is  more 
accessible. 

In  oj)erating,  the  leg  opjoosite  the  one  to  be  bled  is  held  uj) 
and  backward  by  a  strong  assistant,  in  the  posture  of  the  black- 
smith about  putting  on  a  shoe. 


PHLEBOTOMY.  503 

If  tlie  lancet  is  used,  the  operator,  placing  himself  on  that 
side  also,  bends  down,  and,  looking  from  under  the  abdomen  of 
the  horse,  brings  the  instmment  close  to  the  vein,  opening  it  by  a 
rapid  stroke,  and  enlarging  the  orifice  by  a  slight  incising  motion 
of  the  instrument. 

If  the  fleam  is  used,  the  operator  assumes  the  same  position, 
and  applies  it  precisely  as  has  been  described  in  the  cases  akeady 
considered. 

Operating  on  the  right  side  he  holds  the  fleam  with  the  right 
hand  and  strikes  with  the  bleeding-stick  in  the  left,  and  vice  versa. 

This  position  of  the  operator  is  awkward,  and  not  without 
danger,  exposing  him  to  the  chances  of  a  blow  with  the  stifle  of 
the  leg  which  is  held  by  the  assistant.  To  avoid  this,  Peuch  and 
Toussaint  suggest  that  the  assistant,  instead  of  holding  the  leg 
backward,  should  carry  it  forward,  and  that  the  operator  should 
place  himself  behind  the  animal.  It  is  also  claimed  that  in  that 
position  the  vein  is  more  easily  exposed.  The  operation  is  per- 
formed in  the  same  way,  except  that  the  instrument  is  held  with 
the  right  hand  if  one  operates  on  the  left  leg,  and  with  the  left 
hand  if  the  bleeding  is  done  on  the  right  leg. 

The  flow  of  the  blood  in  this  bleeding  is  generally  slabbery, 
and  the  introduction  of  the  pin  of  the  suture  quite  painful,  and 
means  of  restraint  are,  therefore,  often  necessary  before  the  ani- 
mal will  submit  to  the  application  of  the  suture. 

Phlebotomy  on  Other  Supekficial  Veins. 

Others,  besides  the  veins  which  have  been  described,  are  also 
subject  to  phlebotomy,  but  its  performance  is  more  with  some 
local  object  in  view  than  that  of  a  general  bleeding. 

All  are  performed  with  the  lancet,  the  region  (Fig.  446)  where 
they  occur  being  at  the  transversal  of  the  face,  a ;  the  angular  of 
the  eye  (b) ;  the  facial  or  glossofacial,  d ;  the  sxqnrficial  nasal, 
(c)  ;  the  posterior  auricular  (e) ;  the  deep  lingual;  the  inferior 
caudal,  and  the  median  sxibcutaneons  of  i\\.e  forearm.  If  required 
by  their  size  and  position  a  pinned  suture  is  applied  after  the 
bleeding,  but  in  several  instances  pressure  alone  is  sufiicient. 

Phlebotomy   in  Large  Ruminants. 

The  operation  is  confined  to  two  principal  veins  of  the  large 
ruminants.     These  are  the  jugular  and  subcutaneous  abdominal. 


504  OPERATIONS    ON    THE    CIRCULATORY    SYSTEM. 

c 


Fig.  446. 
PHLEBOTOlVrY     ON    THE    JuGULAE. 

It  is  performed  in  the  same  manner  essentially  as  in  the  soli- 
peds,  and  with  the  same  instruments.  But  as  cattle  are  less  sub- 
missive to  the  preparations  which  precede  the  operation,  means 
of  restraint  must  be  used  with  them,  and  they  must  be  tied  to  a 
tree  or  a  post.  The  jugular  of  cattle  has  thicker  walls  than 
that  of  sohpeds,  its  diameter  is  much  greater,  and  it  is  separated 
from  the  carotid  in  its  whole  length  by  a  thicker  layer  of  muscle. 
For  these  reasons  a  larger  fleam  becomes  necessary.  To  dilate 
the  vein  a  strong  ligature  is  applied  tightly  on  the  neck,  the  j)res- 
sure  of  the  fingers  never  being  sufficient  to  furnish  the  necessary 
force.  To  open  the  vein  the  blow  of  the  stick  must  be  heavier, 
and  w^hen  properly  given  is  followed,  as  in  soUpeds,  by  a  strong 
stream  of  blood,  which  rapidly  ceases  when  the  hgature  is  loosened 
or  removed.  It  is  not  always  necessary  to  apply  a  pinned  suture, 
but  it  is  always  safer  and  more  prudent  to  do  so,  though  the  in- 
troduction of  the  pin  is  rendered  difiicult  by  the  toughness  and 
thickness  of  the  skin.  The  value  of  the  pin-holder  is  demon- 
strated in  this  case. 

The  thrombus  which  so  often  follows  this  operation  is  not 
serious,  and,  in  fact,  its  formation  is  stimulated  by  some  practi- 
tioners. 

Phlebotomy  at  the  Subcutaneous  Abdominal. 

This  vein  is  of  enormous  volume,  extending  from  the  udder  to 
the  xyjohoid  cartilage  of  the  sternum,  at  the  side  of  the  abdomen, 


PHLEBOTOMY. 


SO.": 


•to  terminate  in  the  internal  thoracic  vein.  It  is,  therefore,  easily 
recognized,  and  particularly  so  in  milch  cows,  and  it  is,  therefore, 
unnecessary  to  use  the  ligature  or  any  other  means  to  swell  its 
dimensions,  the  pressiu'e  of  the  fingers  being  more  than  sufficient. 
A  fleam  of  medium  dimension  is  preferable  to  the  lancet  in  this 
case.  The  animal  is  firmly  held  by  the  head,  and  to  prevent  his 
kicking,  is  pulled  forward  by  its  tail  passed  between  its  hind  legs. 
In  opening  the  vein  the  operator  places  himself  forward  of  the 
shovdder,  his  back  turned  toward  the  head  of  the  animal,  holding 
the  fleam  with  the  hand  corresponding  to  the  side  of  the  animal 
against  which  he  is  placed.  The  bleeding  is  stopped  with  a  pin, 
or,  what  is  better,  a  bandage,  to  prevent  the  formation  of  a 
thrombus. 

Phlebotomy  on  Small  Animals. 

Bleeding  is  seldom  performed  on  sheep.  When  it  is  indicated 
it  is  performed  on  the /acial,  the  jugular,  the  cephalic,  or  the  ex- 
ternal saphena.     The  vessel  is  opened  with  the  lancet,  the  wool, 


Fig.  447.— Position  of  the  Facial  Vein  in  Sheep. 

if  necessary,  having  been  clipped  off  from  the  place  of  pimcture, 
and  the  wound  is  closed  with  a  pin  suture. 

In  svnne  two  sets  of  veins  are  eligible  for  the  operation,  the 
posterior  auricular,  as  it  runs  at  the  internal  face  of  the  ears, 
and  the  external  saphena,  where  it  passes  along  the  tendo  Achilles. 
The  lancet  is  used  upon  both.  The  first  stops  bleeding  without 
help ;  the  second  is  closed  with  the  pin  suture. 

In  clogs,  ihe  jugular  is  sometimes  opened.  This  vein,  from  its 
position,  requires  the  application  of  a  string  around  the  neck  to 
swell  the  vessel.  The  puncture  is  made  with  a  small  fleam  or  a 
lancet,  and  the  wound  closed  with  a  pin.     The  external  saphena 


506  OPERATIONS    ON    THE    CIRCULATORY    SYSTEM. 

being  quite  large  is  cliosen  in  preference  to  the  internal,  wluch  is 
very  small.  The  place  of  selection  is  the  superior  part  of  the 
vem,  when  it  nearly  reaches  the  posterior  border  of  the  leg.  A 
bandage  is  applied  to  stop  the  hemorrhage.  The  cephalic  might 
be  opened  as  it  passes  toward  the  interior  third  of  the  humerus, 
the  wound  being  closed  by  a  stitch  of  twisted  suture. 

ACCIDENTS  OF  BLOOD-LETTING. 

The  operation  of  blood-letting  may  be  followed  by  several 
complications,  some  being  of  little  importance,  while  others  may 
be  sufficiently  serious  to  compromise  the  life  of  the  patient. 
Among  them  may  be  named :  The  white  and  the  slabbery  bleed- 
ing ;  wounds  of  surrounding  non- vascular  organs  ;  the  thrombus ; 
inflammation  of  the  vein,  or  j)hlebitis  ;  wound  of  the  carotid,  and 
the  introduction  of  air  into  the  veins.  Others,  such  as  the  lesions 
of  nerves,  syncope,  etc.,  are  seldom,  if  ever,  encountered  in  veter- 
inary practice. 

1st — White  and  Slabbery  Bleeding. 

It  is  a  question  whether  these,  properly  speaking,  should  be 
classed  among  the  true  sequelae  of  blood-letting.  We  already 
alluded  to  them  when  describing  the  various  methods  of  perform- 
ing phlebotomy.  They  are  often  the  result  of  the  disposition  of 
the  parts,  the  vein  being  deficient  in  size,  or  more  deeply  situated 
than  natural,  and  thus  imbedded  in  the  loose  suiTOunding  cellular 
tissue ;  or,  perhaps,  the  cause  is  an  imguarded  movement  of  the 
animal ;  and  it  is  often  known  to  be  the  imperfect  manipulation 
of  the  surgeon  in  stiiking  the  fleam  too  lightly,  or  not  vertically, 
and  so  failing  to  bring  the  openings  of  the  skin  and  the  vein  into 
exact  coaptation. 

These  accidents  are,  however,  of  an  unimportant  character, 
and  are  easily  obviated  by  exercising  more  care  and  deliberation. 

2d — Wounds  of  Surrounding  Non- vascular  Organs. 

(a)  Wounds  of  the  Trachea. — The  improper  action  of  the 
surgeon  is  generally  chargeable  with  this  accident.  He  may  have 
erred  in  using  too  large  an  instrument,  or  the  error  may  have  con- 
sisted in  making  excessive  j^ressure  when  ligating  the  neck  with 
the  cord  used  to  eff'ect  the  distension  of  the  jugular.     It  is  a  rare 


ACCIDENTS    OF    BLOOD-LETTING.  507 

accident,  but  may  be  easily  recognized  by  tlie  flow  of  blood  wliicli 
escapes  through  the  nostrils,  and  possibly  by  the  changes  which 
may  affect  the  respiration  by  threatenings  of  strangUng,  suffoca- 
tion, etc.  In  this  serious  case  the  hgation  of  the  blood  vessel  is 
the  only  means  of  stopping  the  hemorrhage. 

(b)  Wounds  of  the  Caudal  Muscles. — This  is  comparatively  a 
common  accident  with  cattle,  but  is  seldom  attended  with  symp- 
toms of  a  serious  character.  The  principal  danger  consists  in  the 
possibility  of  the  formation  of  fistulous  tracts,  more  or  less  re- 
bellious to  treatment,  as  besides  the  muscles,  the  tendons,  and 
even  the  bones  may  have  been  injured  by  the  instrument. 

3d — Thkombus, 

This  is  understood  to  be  a  bloody  tumor,  or  hematoma,  which  is 
formed  around  the  opening  of  the  veiu  by  the  accumulation  of  the 
blood  ia  the  surrounding  cellular  tissue.  It  appears  when  the 
opening  of  the  vein  does  not  accurately  correspond  with  that  of 
the  skin,  or  when  the  iucision  of  the  tegument  is  too  small  to  allow 
a  free  flow  of  the  blood  through  it.  It  often  appears  when  the 
animal  is  allowed  to  rub  himself  after  the  operation,  or  when  the 
opening  of  the  vein  has  involved  a  section  of  one  of  the  valves. 
Some  veins,  as  the  saphena,  the  cubital,  and  the  subcutaneous 
thoracic,  are  more  exposed  to  thrombus  than  others,  even  when 
the  operation  has  been  well  performed  and  completed.  At  these 
veins,  they  are  generally  not  serious,  and  are  readily  subdued  by 
simple  treatment,  if  they  do  not  spontaneously  disappear. 

But  the  thrombus,  which  is  sometimes  encountered  at  the  jug- 
ular, is  of  a  more  serious  character,  and  is  not  unfrequently  com- 
plicated with  phlebitis. 

The  symptoms  of  this  lesion  are  essentially  local,  and  the 
symptoms  and  the  disease  are,  in  efiect,  one,  consisting  of  a  tumor 
of  uncertain,  dimensions,  according  to  the  quantity  of  blood  col- 
lected vmder  the  skin.  In  the  beginning  it  is  roiind,  well  circum- 
scribed, soft,  and  slightly  elastic  to  the  touch,  but  the  swelling 
soon  becomes  hard,  perhaps  oedematous,  or  somewhat  diffused, 
when  it  has  been  caused  by  rubbing  on  the  part  of  the  animal. 

The  simplest  cases  gradually  disappear  after  two  or  three  days. 
But  at  other  times  they  are  not  so  tractable,  and  serious  trouble 
may  ensue,  the  tumor  becoming  stationary,  or  perhaps  increas- 
ing in  size,  and  then  changing  its  character.     It  becomes  warm 


508  OPERATIONS    ON    THE    CIEGULATOKY    SYSTEM. 

and  painful,  assumes  aspects  of  a  phlegmonous  nature,  and  per- 
haps becomes  complicated  with  hemorrhages.  It  is  not  yet  too 
late  to  look  for  resolution,  but  if  it  does  not  soon  take  place,  and 
if  the  symptoms  increase,  and  the  swelling  extends,  the  veiu  is 
changed  into  a  hard,  large  cord,  and  a  case  of  phlebitis  is  estab- 
lished. 

Absorption  and  resolution  are  now  the  two  most  favorable  ter- 
minations of  thrombus,  but  they  are  of  unusual  occurrence,  except 
when  the  tumor  is  of  small  size,  and  j)romptly  attended  to. 

Suppuration  is  the  more  common  event,  and  if  this  continues 
to  be  superficial,  recovery  may  be  looked  for  without  obHteration 
of  the  vein. 

JPhlebltis,  which  commonly  accompanies  a  deep  suppiirative 
thrombus,  is  always  a  serious  termination.  Abscess  of  the  throm- 
bus, however,  may  assume  various  modifications,  and  may  pass  to 
a  chronic  condition,  or  that  of  induration,  or  one  of  still  more 
serious  nature,  that  of  gangrene. 

When  it  has  become  developed,  the  animal  must  be  immedi- 
ately secured  to  prevent  him  from  rubbing  the  parts,  and  as  early 
as  possible  the  treatment  should  be  directed  to  the  limitation  of 
its  development  and  the  promotion  of  its  absorption.  Local  ap- 
23lications  of  cold  water ;  astringent  compresses,  moistened  with 
vinegar  or  lead  solutions ;  povJtices  of  clay,  of  soot,  or  of  chalk, 
mixed  with  vinegar,  will  very  often  be  sufiicient  to  control  or  re- 
move the  growth.  Sometimes,  however,  the  absorption  will  be 
more  effectually  stimulated  by  frictions  with  cantharidis  oint- 
ment, and  in  a  week  or  ten  days  the  thrombus  will  have  entirely 
disappeared.  The  Girard  ointment,  of  Venice  turpentine  and 
bichloride  of  mercury,  is  sometimes  also  very  effective. 

If  the  tumor  assumes  the  nature  of  an  abcess,  and  this  re- 
mains superficial,  it  may  be  opened  with  the  bistoury,  or  the  actual 
cautery,  and  should  hemorrhages  occur  they  must  be  principally 
controlled  by  pressure. 

4th — Phlebitis. 

The  first  effect  of  the  inflammation  of  veins  is  the  coagulation 
of  the  blood  and  the  formation  of  a  clot  in  a  given  length  of  the 
vascular  canal,  adherent  more  or  less  to  the  walls  of  the  vessel,  the 
residt  being  the  partial  or  perhaps  comi:)lete  obliteration  of  the 
vein,  and  hence  a  certain  disarrangement  of  the  cii'ciilation,  which 


ACCIDENTS    OF    BLOOD-LETTING.  509 

may  be  supplemented  by  the  anastomotic  action  of  collateral  ves- 
sels above  and  below  the  occluded  portion.  Or,  again,  the  circula- 
tion may  be  entirely  obstructed,  and,  as  a  consequence  of  the  in- 
flammatory changes,  adhesions  follow,  between  the  clot  and  the 
venous  wall,  the  clot  being  resorbed,  and  the  obliterated  vein 
transformed  into  a  fibrous  cord.  So  long  as  the  inflammation  is 
limited  to  the  internal  wall  of  the  vessel,  phlebitis  is  known  as 
adhesive ;  but  if  it  extends  to  the  external  or  even  to  the  middle 
structure,  and  becomes  suppurative^  it  is  so  distinguished.  Either 
of  these  forms  of  the  disease  may  be  changed  by  a  third  modifica- 
tion to  that  of  hemorrhagic  phlebitis.  These  three  forms  or  diver- 
sities of  the  disease  have  been  established  by  Peuch  and  Tous- 
saint,  whose  views  touching  the  treatment  of  the  affection  we  also 
reproduce,  referring  our  readers  for  the  pathological  history  of 
the  lesion  to  the  various  works  relating  to  it. 

1st.  Adhesive  Phlebitis. — At  the  beginning  of  the  disease,  the 
animal  must  be  placed  under  such  conditions  as  wiU  tend  most 
favorably  to  influence  the  process  of  organization  between  the 
clot  and  the  venous  walls,  and  to  prevent  the  estabHshmeut  of 
suppuration.  To  effect  this  object,  the  enforcement  of  a  state  of 
immobility  in  the  patient  is  most  essential.  His  head  must  be 
firmly  secured  on  both  sides,  and  his  mastication  made  as  easy  as 
possible,  by  suitably  regulating  the  consistency  of  his  diet,  in 
order  to  diminish  the  force  of  the  circulation,  and  so  far  obviate 
the  danger  of  the  displacement  of  the  clot  and  possible  resulting 
hemorrhage.  The  diseased  parts  should  be  treated  by  local  ap- 
pHcations,  among  which  lotions  of  lead  water,  with  continued  cold 
water  irrigations,  will  give  excellent  results.  But  ointments  of 
any  kind  should  be  avoided,  especially  in  warm  weather,  from  their 
liabiUty  to  become  rancid  and  irritant,  and  to  stimulate  the  patient 
to  rub  himself.  The  use  of  cooling  applications  must  be  perse- 
vered in,  in  preference  to  the  frictions  with  vesicatories,  which, 
especially  in  nervous  animals  with  tender  skin,  might  be  liable  to 
encoiu'age  the  suppurative  process.  In  tougher-skinned  animals, 
and  those  of  a  lymphatic  temperament,  in  which  the  inflammation 
has  a  tendency  to  become  chi-onic,  resolvents,  blistering,  liquid 
liniments,  and  alteratives  are  indicated,  and  of  these,  and  first  in 
order,  must  be  named  cauterization  with  the  red  iron.  The 
conical  cautery  is  applied  on  closed,  fine  points,  and  arranged 
quintuply,  every  second  point  being  deep,  while  the  others  are 


510 


OPERATIONS    ON    THE    CIRCULATORY    SYSTEM. 


only  superficial.  By  this  peculiar  mode  of  firing  the  absorption 
becomes  greatly  stimulated,  and  the  resorption  of  the  tumor  very 
rapid.  Cauterization,  however,  if  beneficial  in  chronic,  is  not  so  in 
acute  cases,  having  in  the  latter  a  tendency  to  be  followed  by  sup- 
puration, 

2d.  Snppuratwe  Phlebitis. — For  this  form  of  this  serious  af- 
fection several  modes  of  treatment  are  pro2:)osed. 

{a)  Expectant  Treatment. — This  is  the  plan  by  which  the  j)hy- 
sician  or  surgeon,  administering  palliatives  only,  trusts  to  the  vis 
conservatrix  for  cure,  watching  meanwhile  the  development  of  the 
disease,  and  waiting  for  and  expecting  the  guidance  of  nature  in 
respect  to  his  own  interference. 

(J)  Simple  Incision. — This  is  the  simplest  of  surgical  inter- 
ferences, and  means  nothing  more  than  the  opening  of  the  abscess, 
the  enlargement  of  the  fistulous  tract,  and  the  formation  of  an 
exit  for  the  pus  and  coagulated  blood  which  it  contains.  This  is 
done  with  an  ordinary  bistoiuy,  guided  by  a  probe  or  grooved 
director. 

(c)  Injections. — The  fistulous  tract  which  exists  on  the  phle- 
bitic  tumor  is  washed  with  a  detersive  injection  of  solutions  of 
tincture  of  iodine,  or  perchloride  of  iron ;  or  of  corrosive  subli- 
mate, from  5Uff  to  TTsVff.  These  are  intended  not  only  to  remove 
any  remaining  clots  softened  by  the  suppuration,  but  also  to 
stimulate  the  granulations  and  the  cicatrization. 

{d)  Enlargement  of  the  Fistula  and  Introduction  of  a  Seton. 
— An  S  probe  is  introduced  into  the  fistula,  and  when  it  has 
reached  the  upper  part  of  the  swelling  formed  by  the  vein,  close 
to  the  obturating  clot  (which  must  not  be  disturbed),  an  incision 
is  made  over  its  blunt  end  to  enable  it  to  pass  out  through  the 
skin.  The  fistulous  tract  is  then  enlarged  with  the  straight  bis- 
toury from  below  upward  to  a  small  extent,  and  between  the  two 
openings  a  small  seton  is  passed  by  means  of  the  probe,  and  se- 
cured in  place  by  knotting  the  ends.  The  movement  of  the  seton 
by  drawing  it  to  and  fro,  effects  the  removal  of  such  portions  of 
the  clot  as  may  remain  in  the  wound. 

{e)  Enlargement  of  the  Intra  Venous  Fistxda  in  its  Whole 
length. — This  consists  in  opening  the  tract  from  its  commence- 
ment to  its  superior  cul  de  sac,  as  far  as  the  adhesion  between 
the  clot  and  the  vein  extends,  the  incision  sometimes  reaching 
below  the  ojDening  made  by  the  fleam.     Thus  exposed,  the  tract 


ACCIDENTS    OF    BLOOD-LETTING.  511 

is  washed  out  with  the  tincture  of  iodine  or  perchloride  of  iron 
solution,  or  even  destroyed  with  the  actual  cautery.  The  last  two 
forms  of  treatment,  however,  are  dangerous,  from  their  liability 
to  occasion  consecutive  hemorrhages. 

3d  Ilemorrhagie  Phlebitis. — The  most  serious  incident  of 
phlebitis,  proceeding,  as  it  does,  from  both  the  adhesive  and  the 
sujjpui-ative  forms,  is  the  more  or  less  abundant  hemorrhage, 
which,  resulting  from  any  of  the  various  causes  which  have  been 
mentioned,  may  interfere  with  the  cicatrization  or  obliteration  of 
the  venous  wound.  Three  modes  of  treatment  are  j^racticed  for 
their  suppression.  These  are  the  twisted  and  the  quilled  sutiu'e, 
and  the  ligation  of  the  vein. 

{a)  The  Twisted  Sutiire. — This  consists  in  the  combination  of 
several  (two  or  three)  long  pin  sutures,  placed  upon  the  wound 
made  by  the  fleam,  and  including  a  larger  portion  of  the  skin  at 
the  sides  than  the  single  pin  suture  of  an  ordinary  bleeding. 
Sometunes  wooden  pins  are  substituted  for  those  formed  of  me- 
talHc  material,  and  when  the  sutures  are  completed,  the  wound  is 
strengthened  by  a  coating  of  some  strong,  adhesive  mixture. 
Some  practitioners,  however,  prefer  to  this  the  application  of  a 
severe  blistering  friction,  which,  by  the  pressure  of  the  swelling 
which  it  produces  upon  the  internal  circumjacent  parts,  secures 
practically  all  the  effects  to  be  obtained  by  a  compressive  bandage. 

(b)  Quilled  Sutures. — These  are  applied  on  each  side  of  the 
wound,  securing  a  good  hold  by  placing  them  at  some  distance 
from  the  edges,  and  embracing  tightly  between  them  a  thick  por- 
tion of  the  skin.  This  point  is  important,  for  the  reason  that  this 
portion  of  skin  is  destined  to  be  sacrificed  by  being  left  to  slough 
off,  and  this  must  not  take  place  until  the  obhteration  of  the  wound 
is  entii-ely  completed. 

(c)  Ligature  of  the  Vehi. — The  success  of  this  operation,  to  be 
assured,  requires  the  selection  of  a  healthy  portion  of  the  vein  on 
which  to  place  the  Hgature,  even  if  it  become  necessary  to  look 
for  it  among  the  original  roots  of  the  jugular,  viz.,  the  facial  and  the 
glosso-facial.  In  performing  it,  the  animal  must  be  seciu:ed  in  the 
recumbent  position.  A  single  incision  is  made  through  the  skin, 
the  whole  extent  of  the  obliterated  vein,  jiarallel  to  its  axis,  and 
the  vessel  exposed  and  sej^arated  from  the  surrounding  tissues. 
The  separation,  which  requires  skillful  and  cautious  manij)ulations, 
can  be  effected  by  means  of  either  a  dii-ector  or  a  long  probe.     It 


512  OPERATIONS    ON    THE    CIRCULATORY    SYSTEM. 

will  be  no  more  than  a  wise  precaution  to  apply  a  second  ligature 
below  the  clot,  to  prevent  the  possibility  of  the  escape  of  suppura- 
tive matter  into  the  general  cu'culation.  The  material  of  the 
ligature  may  be  either  ordhiary  linen  cord  or  silk.  Our  own  pref- 
erence is  for  sterilized  catgut.  The  resulting  wound  is  treated  in 
the  manner  proper  for  all  similar  wounds,  and  in  from  twenty  to 
twenty- five  days  complete  recovery  may  generally  be  looked  for 

4th.  Wound  of  the  Carotid. — This  compHcation  of  phlebotomy 
at  the  jugular  is  not  of  common  occurrence,  but  is  easily  possible. 
It  may  become  one  of  the  consequences  of  using  a  fleam  unneces- 
sarily large,  and  out  of  proportion  with  the  dimensions  of  the  vein 
and  the  thickness  of  this  skin ;  or  it  may  be  caused  by  the  exhibi- 
tion of  needless  violence,  in  striking  too  heavy  a  blow  with  the 
bleeding- stick.  Nor  are  these  the  only  causes  to  which  wounds  of 
the  carotid  may  be  referred.  An  abnormal  anatomical  disposition 
of  the  artery,  either  permanent  or  temjsorary,  may  cause  it  to  re- 
ceive the  wound  designed  for  its  neighbor  the  jugular. 

The  symptoms  pertaining  to  this  accident  are  very  character- 
istic. The  color  and  volume  of  the  blood,  and  the  rapidity  of  the 
per  saltum  flow  of  the  stream  are  sufficient  evidences  of  the 
arterial  and  non-venous  source  of  the  hemorrhage.  Concurrently 
with  this,  a  swelling  takes  place  around  the  edges  of  the  wound, 
increasing  with  greater  or  less  rapidity,  and  nearly  resembling  the 
ordinary  thi'ombus  of  venous  extravasation,  though  dififering  from 
it  by  the  rapidity  of  its  formation. 

This  false  aneurism  is  now  subcutaneous,  and  has  a  tendency 
to  extend  itself  downward  toward  the  lower  part  of  the  neck,  and 
has,  indeed,  been  found  extending  as  far  as  the  entrance  to  the 
chest. 

This  accident  is  generally  one  of  a  serious  nature,  not  alone 
in  itself,  but  often  because  of  the  specific  manipulations  which  it 
necessitates  in  order  to  overcome  it.  There  are,  however,  several 
fatal  cases  on  record.  The  indications  of  treatment  may  be  either 
quite  simple,  or,  at  times,  of  serious  import.  If  the  puncture  of 
the  artery  is  but  a  small  one,  and  the  flow  not  abundant,  one  or 
two  strong  pin  sutures  may  be  sufficient  to  control  it,  esjjecially  if 
associated  with  it  steady  and  firm  pressure  is  estabUshed  du-ectly 
upon  the  com-se  of  the  vessel,  either  by  compressive  bandages,  or, 
what  is  better,  with  the  fingers  firmly  pressing  in  the  jugular 
groove.     If,  however,  the  wound  is  large,  and  accompanied  by  a 


ACCIDENTS    OF    BLOOD-LETTING.  513 

correspondingly  profuse  hemon-liage,  it  becomes  necessary  to  have 
recourse  to  the  direct  appHcations  of  a  Hgature.  A  description 
of  this  operation  will  be  made  the  subject  of  our  chapter  on 
hemostasia. 

5th.  Introduction  of  Air  into  the  Veins. — This  is  one  of  the 
most  remarkable  of  the  accidents  attending  the  operation  of  phle- 
botomy. The  phenomenon  has  been  observed  as  early  as  the  seven- 
teenth century,  but  it  was  not  until  1806  that  it  was  observed  and 
recorded  as  belonging  to  the  category  of  casualties  connected  with 
the  familiar  act  of  blood-letting  in  an  animal.  The  first  author  to 
put  the  occurrence  on  record  in  this  connection  was  Verrier,  who 
reported  a  case  in  1806,  and  he  was  soon  followed  by  others  with 
accounts  of  their  experience  with  the  same  lesion  and  operation  in 
human  practice. 

There  are  two  principal  causes  to  which  this  accident  can  be 
attributed.  One  of  these  may  be  an  unnecessarily  large  aperture 
in  the  vein,  but  more  commonly  it  follows  improper  manipulations 
on  the  part  of  the  surgeon,  particiilarly  the  irregular  pressure 
made  upon  the  vein  during  the  flow,  by  many  practitioners,  who 
have  formed  the  habit  of  rubbing  the  vessel  along  its  length, 
under  the  erroneous  idea  that  by  this  movement  they  accelerate 
the  bleeding.  Again,  and  perhaps  principally,  the  casualty  may 
be  the  result  of  neglecting  to  close  the  wound  of  the  skin  with 
the  finger  below  the  point  from  which  the  current  proceeds,  before 
the  pressure  iipon  the  vessel  is  stoj^ped. 

The  occurrence  is  made  known  by  a  peculiar  gurgling  sound, 
which  is  made  more  evident  by  auscultation  of  the  heart.  In  the 
meantime,  the  animal  is  attacked  by  shiverings;  the  respiration 
becomes  accelerated ;  there  is  a  rapid  heaving  of  the  flanks  ;  the 
body  becomes  covered  with  perspiration ;  the  action  of  the  heart 
is  quickened;  the  countenance  becomes  anxious;  the  animal  is 
seized  with  convulsions ;  falls  down  and  dies,  unless  by  the  con- 
tinuance of  the  flow  through  the  open  vein  the  air  may  be  carried 
out  through  the  same  channel  by  which  it  entered,  or  unless  the 
quantity  has  been  very  minute.  As  the  result  of  our  own  study, 
tested  by  many  experiments,  we  have  become  strongly  inclined  to 
believe  that  the  quantity  of  air  necessary  to  produce  death  must 
be  very  large,  more,  in  fact,  than  a  careful  operator  would  allow 
to  enter  without  attempting  to  j^revent  it. 

The  possibHity  of  the  occurrence  of  this  accident  may  easily 


514  OPERATIONS    ON    THE    CIRCULATORY    SYSTEM. 

be  obviated,  seeing  that  it  merely  requii'es  careful  attention  to 
the  execution  of  the  few  details  which  constitute  the  act  of  vene- 
section. But  when  it  has  taken  j^lace,  the  simplest  and  most  ob- 
vious thing  to  do  is,  if  possible,  to  remove  the  air  from  the  vessel 
in  which  it  has  intruded.  The  means  of  effecting  this  consists  ia 
reopening  the  closed  vein,  and  permitting  the  blood  to  resume 
its  flow.  The  loss  of  three  or  four  pounds  of  blood  additional 
is  usually  sufficient  to  insure  the  escape  of  all  the  air.  Gourdon 
recommends,  in  addition,  showering  with  cold  water,  stimulating 
frictions,  and  even,  if  the  case  seems  to  require  it,  artificial 
respiration. 

ARTERIOTOMY. 

Bleeding  from  an  artery  is  so  termed  to  distinguish  it  from 
phlebotomy.  It  is  not  commonly  used  in  practice,  being  princi- 
pally resoi-ted  to  as  a  means  of  local  depletion,  and  is  performed 
only  on  some  of  the  most  suj^erficial  of  the  vessels.  In  fact,  there 
are  but  three  of  these  eligible  by  their  position  to  the  operation. 
These  are  the  transveral  of  the  face,  the  2)oste7'ior  auricnlar,  and 
the  middle  caudal. 

The  7nodus  operandi  differs  but  httle  from  that  of  phlebot- 
omy, except  that  there  is  usually  no  need  of  the  apphcation  of  ar- 
tificial means  to  swell  then-  bulk  or  increase  then*  rotundit}',  their 
position,  and  theu'  distinct  and  characteristic  pulsation,  so  readily 
detected,  sufficiently  revealing  their  location  and  course.  In  open- 
ing arteries  the  fleam  is  seldom  used,  the  lancet  or  a  pointed  bis- 
toury being  a  much  more  eligible  instrument.  The  incision  of  the 
vessel  is  made  across  its  course  instead  of  longitudinally,  as  ia 
phlebotomy,  and  the  flow  of  blood  must  be  arrested  by  means  of 
pressure  with  compresses  or  bandages. 

(a)  Bleeding  at  the  Transve?-sal  of  the  Face. — Though  the 
position  of  this  artery  is  nearly  correspondent  in  all  animals,  it  is 
principally  with  soUpeds  that  it  is  chosen  for  blood-letting.  It  is 
situated  below  the  temporo-maxillary  articulation,  and  crossing 
the  direction  of  the  fibres  of  the  masseter  muscle,  where  it  is  cov- 
ered only  by  a  fine  skin,  it  is  opened  at  the  same  level  with  the 
place  where  phlebotomy  is  usually  performed.  Some  operators 
prefer  casting  the  animal,  others  the  standing  position. 

The  appearance  of  the  vessel  is  that  of  a  small,  round  pulsa- 
ting cord,  and,  as  before  stated,  it  is  incised,  not  as  the  veins  and 


ARTEEIOTOMY. 


515 


opened,  but  in  the  direction  of  its  axis.  The  stream  differs  from 
that  which  flows  from  a  vein,  and  instead  of  issuing  with  a  regu- 
lar flow,  escapes  per  saltiim,  or  by  alternating  leaps,  synchronous 
with  the  action  of  the  heart.  It  also  differs  from  that  of  the  veins 
in  color,  being  of  a  lighter  and  brighter  red.  As  the  apjplication 
of  a  pin  suture  will  scarcely  be  sufficient  to  perfectly  suppress  the 
flow,  pressure  must  be  resorted  to,  either  by  direct  apphcation 
over  the  posterior  border  of  the  maxillary  bone,  or  over  the  place 
where  the  artery  passes,  or  by  covering  the  incision  with  a  pad  of 
oakum,  retained  by  means  of  a  circular  bandage  passing  by  sev- 
eral tm-ns  over  the  upper  part  of  the  head.  The  animal  should 
be  tied  up  for  several  days  after  the  bleeding,  or  until  the  closing 
of  the  artery  is  fully  assured. 

{b)  Bleeding  at  the  Posterior  Auricular. — Though  the  trans- 
versal of  the  face  can  be  opened  in  large  ruminants,  as  well  as  in 
horses,  arteriotomy  in  those  animals  is  more  commonly  performed 
upon  the  posterior  auricular,  where  it  is  attended  by  aU  the  con- 
ditions of  size  and  position  required  to  serve  the  convenience  of 
the  surgeon.  In  cattle,  upon  which  it  has  been  practiced  for  both 
its  general  and  local  effects,  it  has  been,  recommended  in  diseases 
of  the  brain,  and  for  affections  of  the  eyes  and  other  parts  of  the 
head.  The  posterior  auricular  runs  under  the  j^arotid  gland  from 
the  base  of  the  concha  upward  on  its  external  face,  near  its  supe- 


PlG.  448.— Anatomy  of  the  Posterior  Auricular  Artery  in  Cattle. 


516  OPERATIONS    ON    THE    CIRCULATOKY    SYSTEM. 

rior  border,  where  it  loses  itself.  It  is  most  superficial  toward 
the  base  of  the  cartilage  as  it  issues  from  under  the  posterior  cer- 
vico-aui'icular  muscle. 

The  oiDeration  is  comparatively  simple.  The  animal  being  firmly 
held  or  tied  to  a  post  or  a  tree,  hard  friction  is  api^Hed  to  the 
ear  to  stimulate  the  circulation  and  render  the  artery  more  promi- 
nent. The  concha  is  held  by  the  left  hand,  with  the  index  finger 
in  front  and  the  thumb  behind  the  artery,  the  incision  is  made 
by  piercing  the  vessel  with  the  lancet  held  perpendicularly  to  the 
concha,  the  artery  being  cut  directly  across,  and  the  incision  en- 
larged by  a  downward  movement  of  the  instrument.  This  is  fol- 
lowed by  the  appearance  of  a  few  drops  of  arterial  blood,  but 
which  soon  stops  unless  the  flow  is  assisted,  which  is  done  by  the 
operator,  without  releasing  the  ear,  by  striking  light  blows  or  taj^s 
with  a  small  stick  along  the  course  of  the  artery  between  the  in- 
cision and  the  animal's  head.  This  last  step  is  indispensable  to 
obtain  a  good,  free  flow,  ^)er  saltum,  of  course.  This  whipping 
process  is  continued  imtU  the  stream  becomes  abundant,  but  may 
be  susjoended  when  it  reaches  that  point,  to  be  renewed  again, 
however,  if  the  hemorrhage  diminishes.  Artificial  means  to  close 
the  incision  are  not  usually  required,  the  flow  generally  ceasing 
spontaneously,  but  when  that  fails  to  occur  a  pin  suture  or  a 
bandage  at  the  base  of  the  concha,  or  finally  the  Hgation  of  the 
artery,  if  necessary,  will  efi'ect  the  object.  The  animal  must  be 
kept  confined  for  some  time,  to  prevent  him  from  rubbing  the 
wound  or  shaking  his  head  too  violently. 

In  surlne,  this  artery  is  so  easily  reached  that  it  is  often  se- 
lected in  preference  to  other  blood  vessels  which  may  be  more  or 
less  imbedded  in  the  fat  of  the  animal.  The  knowledge  of  its 
position  is  very  important,  as  it  is  very  small  and  difficult  to  find. 
Running  vertically  between  the  temporo-maxillary  joint,  it  reaches 
the  base  of  the  concha,  and  passes  by  the  side  of  its  convex  sur- 
face towards  its  point.  It  must  be  opened  at  the  lower  third  of 
the  cartilage,  where  it  presents  its  largest  dimensions.  The  artery 
must  be  cut  transversely  with  the  lancet.  The  bleeding  ceases 
spontaneously,  or,  if  necessary,  may  be  treated  in  the  manner  in- 
dicated for  cattle.  (Fig.  449.) 

(c)  Bleeding  at  the  Median  Caudal. — In  cattle  this  artery  is 
quite  large  and  very  superficial.  It  runs  along  the  inferior  face  of 
the  tail,  being  covered  at  the  base  of  that  organ  by  the  inferior 


CAPILLAKY   BLEEDING. 


517 


Fig.  449.— Anatomy  of  the  Posterior  Auricular  Artery  in  Swine. 

caudal  muscles,  then  becoming  superficial  and  readily  accessible 
to  the  end  of  the  member.  In  opening  it,  it  is  pierced  by  the 
lancet  in  the  longitudinal  axis  of  the  vessel,  the  tail  being  kept 
elevated.  Ordinarily,  however,  not  only  is  the  artery  cut  directly 
across,  but  the  skin  or  surrounding  muscular  fibres  are  included. 
The  incision  must  be  made  on  a  level  with  the  superior  third  of 
the  tail ;  higher  up  the  operation  may  be  complicated  with  abscess, 
disease  of  the  vertebrse,  sloughing  of  the  tail,  etc.  If  it  becomes 
necessary  to  stimulate  the  flow  of  blood  the  same  "whipping" 
process  may  be  employed  that  was  recommended  in  bleeding  from 
the  posterior  aui'icular.  A  bandage  may  be  appHed  round  the  tail 
to  stop  the  hemorrhage,  though  it  is  not  commonly  needed. 
A  few  practitioners  prefer  to  operate  with  the  fleam. 


CAPILLAEY   BLEEDING. 

The  consideration  of  the  operation  which  consists  in  the  de- 
pletion of  the  minute  extreme  vessels  naturally  and  logically  fol- 
lows that  which  treats  of  a  kinth-ed  procedure  with  the  veins  and 
arteries.  The  intention  of  the  treatment  instituted  for  all  is  the 
same,  and  their  curative  efi^ects  are  adapted  to  similar  ailments. 
These  are  principally  local,  and  may  be  divided  into  two  classes, 
to  wit :  those  which  have  been  in  a  great  measure  discarded  from 
general  practice,  and  those  which  still  retain  their  place  in  the 
domain  of  veterinary  surgery.  The  former  includes  bleeding  at 
the  palate,  the  coronet,  and  the  foot,  and  the  latter  comprehends 


518  OPERATIONS    ON    THE   CIRCULATOKY    SYSTEM. 

the  punctures,  tlie  scarifications,  the  veiitouses,  or  cupping,  and 
the  leeching,  of  regular  current  practice. 

(a)  Punctures  and  Scarifications. — These  are  methods  of 
producing  small  suj)erficial  wovmds  through  the  skin  and  the  sub- 
cutaneous cellular  tissue,  to  obtain  the  effect  of  a  local  bleeding, 
or  the  escape  of  any  other  fluid  contained  in  the  subcutaneous 
substance.  They  are  indicated  against  local  swellings  and  serious 
effusions,  or  oedema  of  the  cellular  tissue.  They  can  be  apphed 
ujDon  any  part  of  the  body,  and  though  they  take  effect  in  the 
escaj)e  of  but  small  quantities  of  fluid,  their  action  may  be  stimu- 
lated by  additional  local  appHcations,  such  as  warm  poultices, 
warm  water  fomentations,  or  diy,  stimulating  frictions. 

Punctiu'es,  however,  are  principally  effective  when  employed 
to  overcome  cedematous  sweUings  of  the  extremities,  and  of  the 
genital  organs,  while  scarifications  are  prescribed  with  better  ad- 
vantage to  obtain  the  resolution  of  cold  or  chi'onic  swellings,  or 
to  control  the  Inflammatory  process  in  cases  in  which  the  tissues 
are  largely  swollen  and  threatened  with  gangrene. 

Both  the  bistoury  and  the  lancet,  and,  in  rare  instances,  the 
fleam,  are  used  in  fulfilling  these  indications. 

In  making  punctm-es  the  skin  and  cellular  tissue  are  pricked 
or  pierced  to  the  depth  required,  with  the  bistomy  or  lancet,  by 
rapid  thrusts  distributed  over  the  entu'e  sui'face  of  the  swelling, 
and  when  the  fleam  is  used  it  is  manipulated  precisely  as  when 
used  in  bleeding,  though,  of  course,  with  qmck  repetitions. 

(5)  Scarifications  may  be  defined  as  rather  small  incisions,  made 
with  a  convex  bistoury,  with  which  the  skin  is  cut  from  without 
inward,  in  parallel  series,  but  which,  in  some  instances,  when  an 
increased  effect  is  desired,  are  doubled  by  a  second  series  crossing 
the  first  at  an  angle. 

(c)  Cupping. — This  mode  of  obtaining  capillary  bleeding  is 
very  seldom  employed  in  veterinary  practice.  The  cups  are,  how- 
ever, indicated  in  subcutaneous  inflammations,  accompanied  w^ith 
sweUings,  and  resulting  from  blows,  contusions,  kicks,  and  other 
and  similar  traumatic  causes,  and  are  often  preferable  to  blisters. 
They  are  recommended  in  arthritis,  ostitis,  and  even  in  internal 
phlegmasia.  They  render  valuable  aid  in  emptying  some  forms 
of  abscesses,  and  are  credited  with  the  possession  of  power. to 
arrest  or  prevent  the  absorjition  of  virus  introduced  into  wounds 
or  deposited  on  then-  surface. 


CAPILLARY   BLEEDING.  519 

There  are  two  modes  of  cupping,  the  dry  and  the  scarified,  or 
•wet.  The  dry  cup  consists  in  the  simple  appUcation  of  the  in- 
strument upon  the  skin  to  produce  a  sweUing,  accompanied  with 
more  or  less  injection  of  the  capillary  vessels,  and  a  local  irrita- 
tion, which  generally  rapidly  subsides. 

The  operation  of  scarified  cupping  consists,  first,  in  applying 
the  instrument  to  produce  the  swelling,  and  when  the  tumefac- 
tion is  sufficient  following  it  with  the  scarificator.  In  completing 
the  first  step,  which  is  the  same  as  for  the  dry  cuppings,  several 
means  are  used.  The  skin  being  prejjared  by  clipping  or  shaving 
off  the  hair,  a  small  glass  globe,  filled  with  heated  air,  is  placed 
over  the  spot  selected  for  the  operation.  A  small  ball  of  wadding 
or  oakum,  either  dry  or  moistened  with  an  inflammable  liquid,  is 
placed  in  the  glass  and  lighted,  and  as  it  begins  to  burn  the  glass 
is  pressed  upon  the  skin.  To  avoid  burning  the  skin,  pumping, 
or  vacuum-cups,  have  been  devised,  some  of  which  are  provided 
with  scarificating  blades.  These  are,  however,  too  complicated 
for  our  general  practice.  When  the  effect  of  the  cupping  is  com- 
pleted, the  red  and  tumefied  skin,  which  is  exposed  as  the  glass 
is  removed,  is  scarified  with  instruments  ad  hoc,  as  the  lancet  or 
the  bistoury,  and  the  cup  is  immediately  reapphed  over  the  same 
spot.  The  blood  then  escapes  freely  from  the  incisions,  and  con- 
tinues to  flow  until  the  cup  is  filled  and  removed. 

{d)  Leeches  are  not  as  frequently  used  in  veterinary  surgery 
as  they  might  be  with  profit.  They  are  well  adapted  to  small 
animals,  such  as  dogs,  whose  fine  and  vasciilar  skin  yields  readily 
to  theii-  appHcation.  For  applying  them  the  skin  is  first  smeared 
with  a  little  milk,  sugai',  or  blood,  and  the  leech,  placed  in  a  small 
glass,  or  cup,  or  clean  pill-bok,  is  brought  in  contact  with  the  skin 
by  reversing  the  cup  or  box  upon  the  chosen  place.  Usually  it 
attaches  itself  at  once,  and  remains  until  it  becomes  gorged  Avith 
blood,  when  it  voluntarily  releases  its  hold.  Sometimes,  however, 
it  is  better  to  place  them  upon  a  thick  compress,  moistened  with 
tepid  water,  and  to  apply  this  over  the  skin.  In  appl;ving  them 
on  the  leg  it  is  a  good  plan  to  cover  them  with  a  cloth,  secured 
with  a  string  tied  about  the  leg  above  and  below,  formiog  a  sort 
of  bag. 

When  the  animal  fails  to  drop  off,  after  being  thoroughly 
gorged,  a  sprinkle  of  salt  speedily  causes  him  to  release  his  hold. 
The  succeeding  hemorrhage  will  ordinarily  cease  after  a  short 


)20 


OPEKATIOXS    OX    THE    CrRCULATOET    STSTEXI. 


time  without  aiJ.  but  if  it  is  desii-able  to  continue  it.  the  parts  may 
be  fomented  with  wai-m  water,  or  covered  with  a  wai-m  poultice, 
(t)  Jjhtdhig  at  the  JPalate. — Bleeding  in  this  region  of  the 
mouth  is  done  by  a  division  of  the  capillai-y  network  which  rests 
between  the  mucous  membrane  and  the  fibrous  coat  which  liaes 
the  bones  forming  the  palate. 

The  bones  rejDresented  by  the  inferior  face  of  the  palatine  pro- 
cess of  the  great  maxillary  bone,  and  the  posterior  face  of  the 
short  j)rocess  of  the  anterior  maxillai-y,  ai'e  covered  with  a  fibrous 
coat,  which  extends  over  their  whole  sui-face  and  the  cartilage 
that  fills  up  the  incisive  sHt.  On  each  side  of  the  palate  i-un  the 
palato-labial  ai*teries,  which,  forward,  form 
an  arch,  and  anastomose  together,  and  give 
rise  to  a  single  branch,  which  enters  the  in- 
cisive canal  formed  by  the  internal  face  of 
the  two  small  maxillaiies.  The  veius,  which 
are  veiy  numerous,  foi*m  a  lai-ge  network 
which  fills  the  space  left  between  these  two 
large  ai'teries.  The  whole  is  covered  by  the 
mucous  membrane,  which  is  white,  rosy, 
thick,  adherent  to  the  fibrous  coat,  and 
showing  a  number  of  mgse,  about  twenty, 
curved  forwai'd  and  diminishing  posteriorly 
in  size  and  prominence.  Anteriorly  they  are 
very  lai'ge.  by  reason  of  the  presence  of  a 
certain  amount  of  ceUulai-  tissue,  which  di- 
minishes by  degrees,  from  before  backward. 
The  anastomosis  of  the  ai-teries  takes  place 
about  on  a  level  with  the  thii'd  rugae  of  the  palatine  sui'face,  and 
it  is,  therefore,  posterior  to  this  that  the  bleeding  must  be  per- 
formed to  avoid  wounding  the  arteiy. 

The  instrument  required  is  the  simple  bistoury,  or  the  one  rep- 
resented in  figure  451.  The  operator,  facing  the  animal,  and  hold- 
ing the  tongue  with  the  left  hand,  draws  it  out  of  the  mouth  on 
the  right  side,  and  with  the  edge  of  the  knife  turned  backward, 
makes  a  small  incision  from  before  backward,  in  the  middle  of  the 
palate  between  the  fourth  and  fifth  rugse.  There  is  no  danger  of 
wounding  the  arteries  if  the  incision  is  made  at  the  proper  place 
and  on  the  median  line.  'When  that  is  the  case,  the  hemon-hage, 
continuing  for  a  variable  length  of  time,  subsides  by  degrees. 


Fig.  450.— CirciOation 
of  tlie  Palate,  mn.  Pala- 
tine mucous  membrane 
«,  grooves  of  tlie  palate; 
a,  palato-labial  artery. 


CAPILLAKY    BLEEDING. 


521 


Fig.  451.— Lancet  to  Bleed  at  the  Palate. 

If,  on  tlie  contrary,  an  artery  has  been  cliyided  and  the  flow  of 
blood  becomes  sufficiently  abundant  and  continuous  to  become 
alarming,  it  becomes  necessary  to  employ  hemostatic  means. 
These  may  be  a  small  sponge  comj)ressed  or  moistened  with  cold 
water  or  an  astringent  solution ;  or,  if  necessary,  a  pad  of  oakum 
can  be  aj)plied  and  secured  with  a  bandage  passed  through  the 
mouth  and  around  the  maxillary  bone,  and  tied  on  the  face.  It 
can  also  be  accomphshed  by  means  of  a  peculiar  bit,  represented 
in  Fig.  452.  This  bit  has  a  small  board  in  its  middle,  and  on  each 
side  of  the  bar  two  straps,  one  to 
act  as  the  check-piece  of  a  bridle, 
the  other  being  passed  over  the 
nose  where  they  are  buckled  to- 
gether more  or  less  tightly.  The 
board  of  the  bar  is  padded,  and  p,^^  452. -Apparatus  to  Apply  Pressure 
is  apphed  directly  over  the  place  *«  "'^'"p  *^®  Bleeding  at  the  Palate, 
of  the  incision.  The  pressure  should  be  continued  for  several 
hours. 

This  operation  was  first  recommended  in  cases  of  stomatitis, 
in  the  pecuhar  form  known  by  the  unmeaning  name  of  kanjKis, 
but  is  resorted  to  for  a  much  better  pm-pose  in  apoplectic  conges- 
tion of  the  head. 

(/)  Bleeding  at  the  Coronet. — In  the  "  Dictionary  of  Veteiin- 
ary  Medicine  and  Surgery,"  Bouley  says :  "  There  exists  on  each 
side  of  the  coronet,  a  rich  superficial  venous  plexus  resting  on  the 
cartilaginous  plates  of  tha  foot,  formed  at  this  point  by  the  union 
of  numerous  veins  of  the  digital  region.  These  veins  are  united 
by  large  communicating  vessels,  nmning  on  the  anterior  and 
posterior  faces  of  the  second  phalanx.  Nothing  is  easier  than 
to  open  one  of  these  vessels  by  plunging  the  point  of  a  bistoury 
through  the  skin ;  the  puncture  being  followed  by  an  abimdant 
flow  of  blood,  and,  if  it  is  repeated,  a  large  bleeding,  quite  as 
abundant  as  that  obtained  by  the  opening  of  another  large  vein, 


522  OPERATIONS    ON    THE    CIECULATORY    SYSTEM. 

can  be  gained.  But  it  is  not  a  matter  of  indifference  whether  the 
puncture  is  made  in  front  or  behind,  or  upon  the  sides  of  the  re- 
gion. It  must  never  be  made  on  the  sides,  because  of  the  danger 
of  injuring  the  cartilage,  several  cases  of  cartilaginous  quittor 
having  been  known  which  were  attributable  to  no  other  cause  than 
bleeding  on  the  side  of  the  coronet.  In  front  the  operation  is  less 
dangerous,  although  a  wound  of  the  tendon  of  the  anterior  exten- 
sion of  the  phalanges  is  possible.  It  is  safer  to  bleed  on  the  pos- 
terior part  of  the  coronet,  where  no  danger  can  be  looked  for. 

This  bleeding  has  been  principally  recommended  as  a  local 
operation  in  cases  of  acute  laminitis. 

(g)  Bleeding  on  the  Foot. — The  toe  is  the  part  selected  when 
bleeding  is  jjerformed  on  the  foot.  It  is  an  operation  which  has 
been  known  for  many  years,  and  imder  various  forms,  and  with 
different  apj)lications  has  been  described  by  Virgilius,  Columelle, 
Absyrtus  and  Vegetius.  It  consists  in  the  incision  and  removal 
of  a  portion  of  the  sole  of  the  foot.  It  is  indicated  in  all  cases 
where  local  bleeding  is  justified,  and  has,  therefore,  been  recom- 
mended in  all  congestions  and  inflammations  of  the  foot,  such  as 
bruises,  burned  soles  and  acute  laminitis,  though  in  this  last  case 
its  execution  is  rendered  difficult  by  the  unwillingness  of  the  ani- 
mal to  support  its  weight  on  one  leg  during  the  operation.  There 
are  several  ways  of  bleeding  at  the  toe. 

1st.  The  Chahert  Method. — A  sjoecial  shoe  must  first  be  pre- 
pared; it  may  be  simply  an  ordinary  shoe  notched  on  its  inner 
border,  which,  without  being  removed,  permits  both  the  opera- 
tion of  bleeding  and  the  subsequent  application  of  a  dressing. 
In  operating,  the  sole  is  pared  out  and  a  groove 
made  between  the  point  of  the  frog  and  the  toe  of 
the  wall,  with  a  drawing-knife,  until  the  soft  tis- 
sues are  reached.  An  incision  is  then  made  with 
the  curved  bistoury  at  the  bottom  of  the  groove, 
between  the  wall  and  the  inferior  border  of  the  os  ^^^  453_shoefor 
pedis,  and  an  incision  made  dividing  all  the  ves-  the  Bleeding  at  the 
sels  that  come  in  contact  with   the   instrument,    ^.f'  ^?^°'^f,'°^  ^^ 

Chabert  s  Method. 

A\Tien  the  flow  of  blood  has  been  sufiicient,  the 
hemorrhage  is  suppressed  by  a  compressing  dressing  of  oakum 
kept  in  place  by  bandages,  or  with  jilates,  according  to  the  condi- 
tion of  the  foot,  and  whether  it  had  been  shod  with  the  notched 
shoe,  or  had  remained  entirely  shoeless. 


SURGICAL    HEMOSTASIA.  523 

2d.  The  Valet  3Iethod. — After  the  preparation  of  the  foot,  as 
with  the  other  method,  a  groove  is  made.  It  is  posterior  and 
parallel  to  the  line  which  marks  the  separation  of  the  wall  and  the 
sole,  and  the  incision  is  made  transverse^,  with  a  bistoury  or  a 
sage-knife.  It  is  usually  followed  by  a  good  flow  of  blood.  An 
ordinary  shoe  is  then  placed  on  the  foot,  and  a  compressing  dress- 
ing of  oakum  put  on  and  kept  in  place  by  plates. 

3d.  Crepin's  Method. — The  difference  between  this  and  the 
other  processes  consists  in  making  the  incision  with  a  narrow  draw- 
ing-knife, which  provides  a  larger  oi^ening  for  the  escape  of  the 
blood.  A  wide-webbed  shoe,  vdth  a  padding  of  oakum  over  the 
wound,  suffices  to  control  the  hemorrhage. 

All  of  these  methods  have  the  same  object  in  view,  but  many 
veterinarians  prefer  to  make  the  incision  a  little  back  of  the  Hne 
separating  the  sole  from  the  wall,  and  right  at  the  toe,  and  they 
sometimes  remove  a  small  portion  of  the  sole  with  the  sage-knife 
or  the  bistoury. 

The  dressing  which  is  required  in  these  cases  must  be  care- 
fully applied,  as  protruding  granulations  may  sometimes  make 
their  appearance,  and  interfere  with  the  cicatrizing  process.  If 
the  hemorrhage  which  accompanies  the  operation  should  be  con- 
sidered insufficient,  it  can  be  stimulated  by  placing  the  animal  in 
a  foot-bath  of  blood-warm  water. 

SUKGICAL  HEMOSTASIA. 

The  extraneous  hemorrhage,  whether  it  be  avoidable  or  un- 
avoidable, which  may  occur  during  an  operation,  forms  one  of 
the  most  embarrassing  of  the  -  interferences  to  which  the  sur- 
geon is  liable,  not  only  from  the  difficulties  it  interposes  in  the 
way  of  the  success  of  the  operation,  by  disturbing  his  manipula- 
tions, but  as  well,  sometimes,  by  the  effect  of  the  loss  of  blood 
upon  the  patient.  It  may  happen,  indeed,  that  instead  of  ceasing 
spontaneously,  or  yielding  to  the  effects  of  the  ordinary  dressings, 
the  hemorrhage  becomes  so  obstinately  persistent  as  in  itself  to 
constitute  a  serious,  and,  if  unsubdued,  a  fatal  accident.  It  be- 
comes necessary  therefore  for  the  operator,  as  one  of  the  practical 
elementary  incidents  of  his  calling,  to  be  always  prepared  in  an 
emergent  case  to  arrest  the  rebellious  circulation  by  jjrompt  and 
efficient  measures.     Hemorrhage  being  an  essential  danger  in  all 


524  OPERATIONS    ON    THE    CIRCULATORY    SYSTEM. 

operations  of  considerable  magnitude,  the  means  of  subduing  it 
should  always,  especially  in  cases  of  that  class,  be  included  among 
the  customary  instruments  and  appliances  of  the  working  surgeon. 
The  flow  may  proceed  from  any  of  the  blood  vessels,  the  arteries, 
however,  from  the  nature  of  then-  functions  and  the  force  of  their 
action,  requiriag  more  frequently  and  more  particularly  the  appli- 
cation of  precautionary  and  remedial  measures. 

Temporary  or  Preventive  Hemostasia. 

This  becomes  necessary  as  an  occasional  expedient,  when  the 
presence  of  the  blood  is  likely  to  become  an  obstacle  to  the  opera- 
tion, and  the  preventive  means  may  be  appHed  either  before  or 
during  its  performance.  Included  under  this  general  head  is  the 
circular  compression,  or  ligation  en  masse,  when  the  situation  and 
the  form  of  the  region  render  it  practicable.  The  effect  of  this 
being  the  flattening  or  collapse  of  the  vessels,  and  the  temporary 
closure  of  their  calibre,  one  of  the  necessary  conditions  of  its  suc- 
cessful application,  especially  with  the  superficial  vessels,  is  that 
they  should  be  situated  near  enough  to  some  structure  sufiiciently 
hard  and  solid  to  fm-nish  an  unyielding  2)oiiit  appui  to  the  com- 
pressing agent.  If,  from  the  jDOsition  of  the  artery,  no  such  point 
of  resistance  can  be  made  available  among  the  surrounding  parts, 
resistance  can  be  established  by  a  double  pressure  made  in  op- 
posite directions,  in  such  a  manner  that  the  compressing  powers 
can  furnish  mutual  support,  each  to  the  other.  By  this  plan  com- 
pression can  be  effected  in  four  different  ways. 

1st.  JBy  Digital  Pressure. — A^Tien  this  can  be  applied  and 
proves  sufficient,  it  is  the  simplest  and  the  best  mode.  While  it 
serves  to  obstruct  the  cu'culation,  its  action  is  limited  to  the  ves- 
sel which  alone  needs  it,  and  the  tissues  are  not  contused  by  the 
pressure;  it  can,  moreover,  be  suspended  or  renewed  at  will,  and 
can  be  managed  by  an  assistant  who  may  be  placed  in  a  position  in 
which  interference  with  the  oi:)erator  can  be  entirely  obviated,  and, 
indeed,  can  sometimes  be  performed  by  the  surgeon  himself.  It 
is  obtained  by  pressing  the  vessel  with  the  tips  of  the  fingers 
placed  either  vertically  upon  the  vessel  itself,  or  along  its  course  ; 
and  only  such  a  moderate  degree  of  force  need  be  employed  as  will 
prove  sufficient  to  close  the  calibre  of  the  vessel,  without  fatiguing 
the  hand  by  uimecessary  pressure. 


SURGICAL    HEMOSTASIA.  525 

2d.  Compression  vnth  the  Circular  Ugature. — Either  a  band- 
age or  a  circular  string  of  sufficient  strength  may  be  employed  in 
this  method.  If  needed  upon  the  leg,  it  should  be  placed  upon 
the  lower  part  of  the  limb,  either  dry  and  moderately  tight,  or 
moistened  with  cold  water.  If  kej^t  in  place  for  a  certain  length 
of  time  previous  to  an  operation,  the  effect  will  be  to  so  reduce 
the  force  of  the  circulation  in  that  part  as  to  render  the  perform- 
ance comparatively  a  bloodless  one.  This  proceeding  is  often 
associated  in  veterinary  practice  with  the  operation  of  neurotomy. 
In  operations  upon  the  foot,  comparatively  perfect  hemostasia 
may  be  obtained  by  circumscribing  the  coronet  with  a  ligature 


Fig.  454.— The  Adstrictor  of  Brogniez. 

formed  of  a  strong  circular  string,  tightly  drawn,  but  as  a  substi- 
tute for  this,  a  special  instrument  has  been  invented  by  Brogniez, 
which  he  calls  the  adstrictor,  which  secures  the  same  results. 

3d.  Compressio7%  by  the  Tourniquet. — The'  adstrictor  of  Brog- 
niez is  but  a  peculiar  form  of  tourniquet,  which  is  composed  of 
two  oval  cushions  or  pads  supported  by  metallic  plates,  and  se- 
cured on  the  inner  face  of  a  circular  band  adjustable  as  to  its 


Fig.  455.— Tourniquet. 

length,  and  secured  by  a  common  buckle.  This  band  is  buckled 
around  the  leg,  and  the  pressure  is  made  by  the  pads,  which  are 
laid  directly  over  the  course  of  the  vessel. 

4th.  Compression  hy  Esmardc's  Method. — Another  mode  of 
compression,  borrowed  from  human  surgery,  that  of  Professor  Es- 
marck,  is  designed  to  wholly  prevent  the  loss  of  blood,  and  enable 
the  surgeon  to  perfoim  a  perfectly  dry  or  bloodless  operation.    It 


526  OPEKATIONS    ON    THE    CIRCULATORY    SYSTEM. 

consists  of  a  roller  of  India  rubber,  to  be  so  aj)plied  around  the 
seat  of  the  operation  as  to  cause  the  blood  to  recede  toward  the 
center  of  the  body,  its  return  being  prevented  by  firmly  placing- 
a  ligature  just  above  the  point  of  incision.  The  pressure  pro- 
duced by  this  band  can  be  regulated  by  means  of  a  toiu-niquet, 
or  a  piece  of  elastic  tubing,  or  an  ordinary  string  that  may  be 
twisted  with  a  stick.  This  mode  of  compression  is  adapted  to 
cases  of  amputation  of  the  limbs  and  of  the  tail,  or  the  removal  of 
tumors. 

Permanent,  or  Definite  Hemostasia. 

The  arrest  of  hemorrhage  may  become  necessary  at  any  step 
of  an  operation,  Lut  it  is  ordinarily  when  it  has  been  completed 
that  the  indication  must  be  fiilfiUed.  It  is  true  that  in  many  in- 
stances, even  after  extensive  lesions,  the  hemorrhage  will  cease 
spontaneously,  but  it  is  equally  true  that  at  other  times  special 
interference  becomes  a  necessity.  If  the  hemorrhage  is  capillary, 
the  surgeon  may  safely  overlook  it,  and  leave  it  to  subside  under 
the  influence  of  the  retractihty  of  the  tissues ;  but  if  it  is  of  ve- 
nous origin,  it  cannot  be  safely  left  to  spontaneous  action.  Still, 
usually  it  is  only  when  one  of  the  larger  veins  is  the  seat  of  the 
bleeding  that  danger  becomes  imminent,  as  with  those  situated 
near  the  center  of  the  cu'ctdatory  system  ;  but  serious  accidents 
are  seldom  to  be  feared.  If  the  vein  is  cut  across,  moderate  pres- 
sure upon  the  orifice  will  generally  insure  the  formation  of  a  clot 
which  will  constitute  a  sufficient  plug,  or  if  the  vera  is  opened 
longitudinally  by  a  lateral  incision,  pressure  at  the  point  of  the 
wound,  though  not  strong  enough  wholly  to  stop  the  circulation 
within  the  vessel,  may  still  be  sufficient  to  assure  the  rapid  obliter- 
ation of  the  wound.  But  when  large  veins  or  arteries  are  oj^ened, 
or  even  when  the  capillary  hemorrhage  is  usually  abundant,  more 
complicated  means  of  hemostasia  must  be  resorted  to,  and  not 
only  applied  carefully  and  securely,  but  also  with  celerity.  The 
means  of  obtaining  permanent  hemostasia  are  of  two  kinds — one 
taking  effect  through  ihe physico-chemical  action  of  special  agents, 
the  other  including  those  which  are  known  as  surgical  means 
proper. 

Physico-Chemical  Hemostatics. 

Among  these  must  be  considered  the  refrigerants,  absorbents^ 
astringents  or  stgj^tics,  and  2>otential  and  actual  cauterization. 


SURGICAL    HEMOSTASIA.  527 

1st.  Refrigerants.  —  The  agents  included  in  this  class  act 
almost  exclusively  by  dejoriving  the  parts  upon  which  they  are 
appUed  of  their  heat,  and  in  producing  a  certain  excitation  upon 
the  vaso-motor  nerves,  followed  by  a  toxic  contraction  of  the  mus- 
cular fibres  of  the  vessels,  and  the  diminution,  or  sometimes  the 
complete  arrest,  of  the  bloody  flow.  Their  action  is  principally 
efficacious  on  vessels  of  small  cahbre,  such  as  the  capillaries. 

Cold  water,  snow,  cracked  ice,  and  the  very  volatile  liquids,  as 
ether,  chloroform,  and  freezing  mixtures,  fill  an  important  place  in 
this  category.  In  veterinary  surgery,  cold  water,  being  the  sim- 
plest, the  most  accessible  and  abundant,  and  the  easiest  to  apply, 
heads  the  list.  It  is  used  in  the  form  of  douches,  baths,  lotions 
and  injections,  or  by  means  of  compresses,  pads,  or  cushions  of 
oakum  laid  upon  the  seat  of  hemorrhage.  The  saline  mixtures, 
and  the  snow  or  cracked  ice,  are  placed  in  cloths,  bags  or  blad- 
ders, but  their  action  must  be  watched  in  order  to  obviate  the 
possibiHty  of  congelation  and  mortification  of  the  tissues,  quite  a 
possible  result  of  excessive  refrigeration. 

Kefrigerants  are  generally  considered  as  forming  the  least  ef^ 
fective  of  hemostatics,  but  their  facility  of  ajDplication  has  brought 
them  into  common  use.  They  are  principally  indicated  against 
external  capillary  bleeding,  or  that  which  escapes  from  a  small 
vessel,  but  would  generally  prove  insufficient  against  a  hemor- 
rhage from  a  large  vessel.  They  may,  however,  prove  advanta- 
geous against  some  internal  hemorrhages,  which,  though  they 
may  be  controllable  by  other  dh-ect  means,  yet  can  be  reached  by 
the  water  without  difficulty  or  danger,  and  act  directly  or  by  con- 
tinuity in  producing  the  necessary  contraction.  In  this  manner, 
injections  into  the  nasal  cavities,  or  the  uterus,  or  rectum  are 
often  efficacious  in  arresting  a  hemorrhagic  flow  suddenly  occur- 
ring. But  in  any  case,  refrigerants  should  be  api^lied  with  care, 
and  their  efiect  watched.  If  they  are  allowed  to  remain  too  long 
in  place,  or  the  temperature  be  too  low,  they  may  induce  an  in- 
flammatory reaction  and  local  gangrene,  or  produce  other  dan- 
gerous general  effects  upon  the  internal  economy.  On  the  other 
hand,  if  imperfectly  applied,  and  without  a  sufficient  degree  of 
cold,  their  action,  already  weak,  will  become  a  mere  useless  nega- 
tion, if  not  worse.  Between  these  two  extremes  there  is  a  middle 
course,  which  the  competent  surgeon  wiU  be  able  to  observe  by 
exercising  his  discretion,  and  an  appeal  to  his  own  experience. 


528  OPERATIONS    ON    THE    CIRCULATORY    SYSTEM. 

2d.  Abso7'bents.  —  Hemostatic  absorbents  jjroper  are  agents 
wbicli  by  tlieir  caiDillary  action  suck  up  or  soak  in  the  sanguineous 
element  from  traumatic  surfaces,  and  having  their  structure 
thickened  and  condensed  by  the  presence  of  this  contained  liquid, 
coagulated  in  their  mass,  opi)ose  thereby  an  invincible  obstacle  to 
the  escajDe  of  the  blood.  Oakum,  charpie,  punk,  spider-webs, 
flour,  fuller's  earth,  sponge,  and  various  vegetable  powders  be- 
long to  this  catalogue  of  medicaments.  Oakum,  which  is  the 
substance  which  meets  with  general  favor  and  is  most  commonly 
used,  is  applied  in  the  form  of  balls,  dry,  or  soaked  in  cold  water, 
and  packed  over  or  into  the  depth  of  a  wound,  and  kept  in  place 
with  bandages  or  compresses. 

Compressed  sponge  has  proved,  in  our  hands,  an  excellent 
hemostat,  not  only  in  capillary  bleeding,  but  in  that  also  of  me- 
dium-sized vessels.  There  is,  however,  an  objection  to  its  use  in 
the  fact  of  its  liabihty  to  become  adherent  to  the  tissues  with 
which  it  is  in  contact,  and  the  consequent  danger  of  renewing  the 
hemorrhage  when  removing  it. 

3d.  Astringents,  or  Sty2')tics. — These  agents  produce  the  co- 
agulation of  the  blood,  by  a  chemical  action,  resulting  from  the 
combination  of  the  astringent's  substance  with  the  U\Tng  tissues. 
Their  action  differs  essentially  from  that  of  the  refrigerants  in 
the  fact  that  they  possess  the  special  property  of  producing,  by 
their  power  of  fibrillar  astriction,  the  occlusion  of  the  vessels 
through  the  coagulation  of  the  blood  in  their  interior. 

Astringents  are  used  in  both  the  solid  and  the  liquid  form. 
Burnt  alum  in  powder,  and  certain  vegetable  powders,  belong  to 
the  first  class.  The  solution  of  sulphate  of  iron,  sulj)^ate  of 
copper,  alum,  acetate  of  lead,  alcoholized  water,  solution  of  tannic 
acid,  etc.,  are  included  in  the  second.  They  must  be  judiciously 
used,  however,  because  of  their  liability  sometimes  to  excite  local 
inflammations,  more  or  less  active.  The  action  of  the  liquid  as- 
tringents is  deeper,  more  energetic,  more  lasting,  and  more  dur- 
able than  that  of  the  solid,  and  they  are  for  that  reason  sometimes 
more  reliable  for  the  control  of  hemon-hages  from  large  vessels. 
Their  consistency  renders  them,  of  course,  alone  available  for 
moistening  compresses,  balls,  the  tampon,  or  pads  of  any  descrip- 
tion. The  most  powerful  of  this  class  is  the  perchloride  of  iron, 
which  is  remarkable  for  its  power  of  coagulating  the  blood  almost 
instantaneously.     When  applied  with  oakum  upon  a  bleeding  sur- 


SURGICAL    HEMOSTASIA. 


529 


face  it  forms,  with  the  blood,  a  blackish  magma,  and  a  resisting, 
strongly-adherent  clot  in  the  cavity  of  the  vessel. 

4th.  Potential  Caustics. — The  chemical  astringents  have  gen- 
erally the  same  mode  of  action.  Upon  being  placed  in  contact 
with  the  tissues  they  enter  into  combination  with  their  elements 
and  form  a  coagulum,  and  it  is  the  presence  of  this  clot  which 
produces  the  hemostatic  effect.  They  are  but  little  used,  how- 
ever, in  veterinary  practice.  The  nitrate  of  silver,  some  of  the 
mineral  acids,  as  sulphuric,  nitric,  or  arsenious,  or  bichloride  of 
merciuy,  are  the  potential  caustics  which  are  occasionally  used, 
though  it  should  always  be  with  great  caution,  in  view  of  the 
possible  danger  of  producing  an  excessive  effect. 

5th.  Actual  CauteHzatioti. — Cauterization  with  the  hot  iron 
is  the  oldest  and  principal  hemostatic  in  use  in  the  surgical  treat- 
ment of  the  domestic  animals,  and  in  many  instances  may  be  made 
to  supersede  all  the  chemical  agents  we  have  considered,  more 
especially  in  cases  of  capillary  hemorrhage.  It  is  applied  with 
the  iron  heated  to  a  white  heat,  and  laid  upon  the  bleeding  sur- 
face, where  it  immediately  creates  a  thick,  impermeable  eschar, 
adherent  to  the  wound,  and  offering  an  insurmoimtable  barrier 
to  the  escape  of  the  blood. 

To  obtain  all  the  effect  desired  the  wound  must  be  thoroughly 
free  from  all  extraneous  substances,  liquid  or  solid,  that  nothing 
may  interfere  with  the  rapid  formation  of  the  eschar.  The  blood 
should  be  well  soaked  out,  a  plug  of  oakum  firmly  pressed  uj)on 
the  wound,  and  the  iron  pressed  perpendicularly  upon  the  tissues ; 
this  rai)idly  forms  the  eschar.  The  application  of  the  cautery 
must  be  continued  for  a  few  seconds  only,  on  account  of  its  ha- 
bility,  while  cooling  off,  to  adhere  to  the  tissues  and  to  the  eschar, 
with  the  consequent  risk  of  reopening  the  wound  and  renewing 
the  hemorrhage  upon  attempting  its  removal.  It  is  better  if  the 
eschar  is  not  sufficiently  thick,  after  a  first  application,  to  renew 
it  a  second,  or  even  a  third  time,  always  taking  the  same  precau- 
tions; and  being  careful  to  avoid  contact  with  sound  tissues. 

In  this  operation  it  is  essential  that  the  temperature  of  the 
cautery  should  be  at  its  maximum.  Half-heated,  or  cooled  off  by 
the  blood,  not  only  is  the  apphcation  more  painful,  but  the  effects 
are  incomplete  and  the  hemoiThage  is  likely  to  return.  If  the 
blood  escapes  too  freely,  or  coagulates  too  slowly,  the  eschar  not 
forming,  it  may  sometimes  become  necessary  to  carbonize  the 


530  OPERATIONS    ON    THE    CIKCULATORY    SYSTEM. 

bleeding  svirface  by  means  of  some  combustible  substance  which 
will  furnish  more  solid  materials  for  the  protective  scar.  A  loop 
of  hair,  or  some  pulverized  rosin,  placed  upon  the  wound,  and 
burnt  with  the  cautery,  often  fulfills  the  requu'ements.  For  hem- 
orrhage from  parts  below  the  surface,  the  edges  of  the  wound 
must  be  separated  before  the  cautery  is  introduced,  to  prevent  its 
coohng  before  reaching  the  proper  point  of  application.  When 
the  eschar  is  well  formed  and  estabhshed  it  should  be  left  without 
interference  to  complete  the  process  of  sloughing. 

The  thermo-cautery,  with  which  the  required  heat  can  be  re- 
tained at  a  uniform  degree,  is  one  of  the  best  instruments  for 
the  application  of  this  mode  of  hemostasia,  there  being  no  need 
of  removing  it  until  an  eschar  of  sufficient  thickness  has  been  ob- 
tained. 

Surgical   Hemostatics. 

Among  the  numerous  surgical  means  of  obtaining  both  per- 
manent and  definitive  hemostasis,  there  are  three  which  principally 
merit  our  attention :  compressioti,  ligature  and  torsion. 

(A)  Compression. — We  have  already  referred  to  this  method 
while  considering  the  subject  of  temporary  hemostasia.  There 
are  cases  in  which  it  acts  as  an  excellent  mode  of  permanently 
controlling  hemorrhage,  whether  proceeding  from  arterial,  venous 
or  capillary  sources,  and  equally  whether  from  a  large  surface  or 
from  a  deep  cavity,  where  the  origin  of  the  hemorrhage  cannot  be 
distinctly  located.  Still,  for  arterial  hemorrhages  it  is  only  effica- 
cious for  vessels  of  small  or  medium  size,  or  when  the  wounds  are 
of  small  dimensions.  There  are  secondary  circumstances  which 
determine  the  designations  of  certain  variations  of  pressure.  One 
is  the  situation  of  the  vessel,  relatively  to  that  of  the  bleeding 
orifice,  when  the  pressure,  to  be  effective,  must  therefore  be  direct 
or  lateral,  and  with  the  latter,  either  mediate  or  immediate.  Some- 
times, again,  it  is  applied  at  a  distance  from  the  bleeding  point, 
and  in  an  indirect  manner,  and  involves  an  alternative  between 
l^higging  and  direct  compression.  It  is  aj^plied  to  the  wound 
itself  when  the  vessel  has  been  cut  directly  across.  It  is  usually 
effected  by  covering  or  fiUing  the  wound  with  a  dressing  of 
balls  of  oakum  applied  directly  upon  the  bleeding  orifice,  and 
covering  these  with  pads,  increasing  in  dimensions  as  they  become 
more  superficial.     The  whole  apparatus  is  submitted  to  pressure 


SURGICAL   HEMOSTASIA.  531 

by  approximating  the  edges  of  the  wound,  as  much  as  possible, 
by  means  of  interrupted,  pin,  or  a  quill  sutui'e  ;  or  sometimes 
a  circular  bandage  of  dry  or  compressed  sponge,  cut  into  small 
pieces,  may  be  used  in  the  same  manner  as  the  oakum  with  ex- 
cellent effect,  especially  when  the  hemorrhage  is  abundant,  or 
ligation  become  impracticable. 

The  objection  to  the  mode  of  compression,  generally  speaking, 
is  its  liability  to  become  loosened  in  consequence  of  the  softened 
and  yielding  condition  of  the  surrounding  tissues.  For  this  rea- 
son the  mode  of  applying  the  force  directly  is  not  often  practiced, 
or,  at  least,  is  adopted  only  when  the  hemorrhages  are  small  and 
controllable  by  slight  pressure,  or  in  case  of  the  section  of  an  in- 
comj^ressible  artery,  like  that  of  a  bone. 

In  order  to  increase  the  effect  of  direct  pressure  the  surgeon 
sometimes  has  recourse  to  the  joint  use  of  some  of  the  physico- 
chemical  hemostatics  before  mentioned. 

( a )  Immediate  Lateral  Compression.  —  This  is  practiced 
against  hemorrhages  due  to  lateral  wounds  of  blood  vessels,  and 
is  applied  directly  upon  the  opening  in  the  vessel.  The  method 
of  its  application  does  not  differ  from  that  of  direct  compression, 
and  it  is  Hable  to  the  same  objections  in  its  irritating  effect  upon 
the  surface  of  the  wound  and  consequent  interference  with  cica- 
trization, and  the  danger  of  a  renewal  of  the  bleeding.  More- 
over, if  the  vessel  is  without  a  solid  resting-place,  and  there  is  no 
sufficient  resisting  point,  hemorrhage  is  not  arrested.  But  again, 
in  a  contrary  condition,  it  may  be  followed  by  gangrene  or  the 
obUteration  of  the  vessel,  and  if  the  wound  is  of  such  a  form  that 
this  last  accident  cannot  be  avoided  it  is  better  to  have  immediate 
recourse  to  the  ligature.  It  remains,  then,  that  this  mode  of  hem- 
ostasia is  only  ad\dsable  when  the  wound  is  small  and  the  artery 
small  and  superficial,  or  in  such  a  position  that  it  cannot  be  ligated. 

Immediate  lateral  compression,  however,  can  be  made  with 
great  benefit  with  the  finger  upon  the  wound,  pressing  with  the 
necessary  force  to  prevent  the  escape  of  the  blood,  without  clos- 
ing the  cahbre  of  the  vessel.  The  finger  is  kept  in  position  for 
one  or  two  hours,  with  an  occasional  insi)ection  to  discover  whether 
the  hemorrhage  has  ceased,  and  when  it  is  I'emoved  there  remains 
but  a  simple  wound,  easy  to  dress. 

This  mode  of  compression  has  the  advantage  of  obviating  the 
accidents  that  may  occur  from  excessive  external  pressure  main- 


532  OPEEATIOXS    ON    THE    CIRCULATOKY    SYSTEM. 

tained  by  ligatures  and  dressings,  such  as  the  division  of  the  skin 
and  the  possibihty  of  gangi-ene.  The  vakie  of  this  measure  of 
digital  compression  may  be  estimated  by  the  fact  of  its  successful 
application  to  a  vessel  of  the  dimensions  of  the  carotid  artery  in 
a  case  of  a  wound  by  pricking. 

(b)  Jlediate  Lateral  Compression. — The  compression  here  is 
applied  outside  of  the  solution  of  continuity,  in  such  a  manner  as 
to  leave  a  certain  thickness  of  the  tissues  betvpeen  the  injvu'ed  ves- 
sel and  the  compressing  apparatus.  It  may  take  effect  either 
directly  upon  the  wound  itself,  or  elsewhere  along  the  course  of 
the  vessel.  It  can  be  effectively  made  only  upon  superficial  ves- 
sels, principally  arteries  which,  like  those  of  the  extremities,  lie 
upon  or  near  enough  to  resisting  surfaces  to  furnish  a  means  of 
support  to  the  pressure.  The  manner  in  which  temporary  and 
permanent  hemostasia  can  be  obtained  is  the  same,  excepting  that 
the  cords,  bandages  and  tourniquet  are  replaced  by  graded  com- 
presses, supported  by  rollers  or  appropriate  bandages,  which  are 
continued  only  dui'ing  the  existing  necessity. 

The  objection  to  this  hemostatic  method,  and  which  it  shares 
with  all  the  other  processes  of  compression,  is,  that  when  a  large 
vessel  is  to  be  compressed,  and  a  certain  amoimt  of  force  becomes 
necessary,  other  tissues,  with  other  vessels,  veins  and  nerves  alike, 
must  participate  in  the  same  pressure,  and,  as  a  consequence,  dis- 
turbances of  varying  degrees  of  sevei'ity  will  occm-  in  parts  situ- 
ated beyond  the  comijressed  surface,  proportioned  to  the  duration 
of  their  exposure  to  the  acting  cause.  Hence  the  indication,  in 
applying  the  apparatus,  to  begin  at  the  peripheric  portion  of  the 
region,  to  cany  it  toward  the  center,  in  passing  over  the  wound 
akeady  protected  and  covered  by  the  balls,  pads  or  compresses, 
which  constitute  the  true  means  of  compression. 

The  principal  objections  to  this  process  of  hemostasia  can  be 
obviated  by  leaving  on  the  apparatus  only  for  the  minimum  time 
necessary  to  obtain  the  cicatrization  of  the  wound  of  the  vessel, 
which  will,  of  course,  vary  according  to  circumstances,  and  will 
be  especially  influenced  by  the  consideration  whether  the  cahbre 
of  the  vessel  is  to  be  preserved  or  obliterated. 

If  the  vessel  be  a  small  one,  the  wound  of  small  dimensions,  and 
the  continuity  of  the  channel  is  to  be  preserved,  a  few  hours  will 
be  sufficient ;  or,  if  otherwise,  it  is  to  be  obliterated,  one  or  two 
days  will  be  required,  or  even. at  times  one  or  two  weeks. 


SURGICAL    HEMOSTASIA.  533 

(e)  Plugging. — This  mode  of  compression  is  chosen  as  a  per- 
manent hemostatic  to  arrest  hemorrhages  which  occur  upon  the 
surface  of  natural  cavities,  or  upon  wounds  where  the  injured 
vessel  cannot  be  reached.  This  is  done  with  balls,  or  pledgets  of 
oakum  or  sponge,  carried  with  a  forceps  to  the  bottom  of  the 
caxdties,  or  with  sachets,  arranged  in  the  manner  of  the  tampon, 
impregnated  with  an  astringent  solution  or  a  cold  mixture,  the 
whole  being  kej)t  in  place  by  the  dressing  which  closes  the  cavity. 
It  is  used  in  cases  of  epistaxis  and  hemorrhages  from  the  uterus, 
or  those  following  castration.  But  with  all  its  advantages  it  is  an 
uncertain  mode,  and  oj)poses  but  a  shght  obstacle  to  the  hemor- 
rhage ;  besides  which  it  irritates,  by  the  pressure  of  the  plugging 
material  on  the  parts  with  which  it  is  in  contact,  where  it  acts  in 
the  manner  of  a  foreign  body,  which  in  fact  it  is,  giving  rise  to 
some  pain,  and  perhaps  stimulating  muscular  contractions,  and 
thus  exciting  the  hemorrhage  anew.  However,  these  objections 
are  not  of  sufficient  weight  to  contra-indicate  its  employment 
as  a  ready  and  efficacious  means  of  hemostasia,  or  to  prevent 
it  from  being  wisely  appreciated  and  largely  employed  by  the 
surgeon. 

(B) — Ligature. — The  Ugature  is  the  typical  and  obvious  means 
of  hemostasia — the  hemostat  jOrtr  excellence — perfect  in  its  sim- 
pHcity,  though  consisting  simply  in  tying  a'  circular  thread  or 
cord  around  the  wounded  vessel  with  sufficient  tension  to  close  its 
channel,  suppress  the  cu'culation,  and  convert  the  tube  into  a 
cord.  It  can  be  applied  either  on  the  cut  extremity  of  an  artery, 
or  upon  its  continuity.  It  is  seldom  appHed  upon  veins,  however, 
from  its  HabUity  to  induce  phlebitis,  but  still,  it  is  resorted  to  in 
wounds  of  large  veins,  or  when  the  hemorrhage  cannot  be  con- 
trolled by  other  means. 

As  with  compression,  ligature  may  be  irmnedlate  or  mediate^ 
and  may  also  be  divided  into  temporary  and  permanent — temr- 
porary,  when  its  continuance  depends  upon  some  contingency — 
permanent^  when  it  is  to  remain  until  it  is  eHminated  by  suppura- 
tion, or  becomes  organized  and  absorbed,  as  when  the  ligating 
thread  is  composed  of  some  special  animal  fibre — which  is  the 
kind  most  commonly  used. 

The  instruments  required  for  this  operation  are  :  tenaculum, 
aneurism  needle,  Hgature  materials,  ordinary  dissecting  or  bull- 
dog forceps,  scalpel  or  bistoury,  and  the  grooved  director. 


534 


OPERATIONS    ON    THE    CIKCULATORY    SYSTEM. 


The  kind  of  forceps  used  are  known  as  artery  forceps,  and 
are  of  numerous  varieties. 


Fig.  457.— Cooper  Needles,  or  Tenaculum. 

The  tenaculum,  or  aneurism  needle,  is  a  kind  of  blunt  tenacu- 
lum with  an  eye  at  its  end,  and  is  used  to  seize  or  secure  the 
vessels. 

The  suture  materials  are  linen  thread,  silk,  animal  Hgatures, 
such  as  catgut  or  tendinous  fibrilla,  and  sometimes  very  fine  me- 
tallic wire.  Ordinary  linen  thread  and  silk,  well  waxed,  are  most 
commonly  used  in  veterinary  practice. 

(a)  Immediate  Ligature. — This  is  the  surest  of  hemostatic 
means.  It  is  applied  principally  upon  large  arteries  surrounded 
ordy  by  their  cellular  sheaths,  and  a  difference  is  made  in  applying 


SURGICAL    HEMOSTASIA.  535 

it  between  vessels  wliicli  are  perfectly  intact  and  those  whicli 
have  been  partially  cut  through  or  otherwise  injured. 

The  Immediate  Ugating  of  an  artery  entirely  divided  includes 
but  two  steps :  the  prehension  of  the  artery  and  the  adjustment 
of  the  hgature. 

When  drawn  out  of  its  position  with  the  proper  forceps  the 
artery  must  be  carefully  examined  for  possible  adhesions,  and 
especially  any  nervous  threads  which  may  be  attached  to  its  sur- 
face— all  of  which  must  be  dissected. 

In  j)lacing  the  ligature  many  operators  carry  the  thread,  form- 
ing a  loop,  with  the  forceps,  and  on  seizing  the  artery  and  seeing 
that  it  is  clear  from  the  surrounding  tissues,  they  slip  the  loop 
down  over  the  instrument  upon  the  vessel,  to  be  tied  by  an  assist- 
ant. The  apparent  simplicity  of  this  movement  is  deceptive  ;  too 
often  the  loop  of  the  ligatm-e  adheres  to  the  wound,  the  ends  roll 
over  themselves  and  one  another,  the  Ugature  cannot  be  properly 
placed  over  the  vessel,  and  the  knot  is  tied  over  the  forceps  before 
the  thread  has  reached  the  artery.  To  avoid  this  it  is  better,  when 
the  vessel  has  been  weU  secured  and  isolated,  to  have  the  assistant 
apply  the  ligature  by  its  middle  upon  the  jaws  of  the  forceps,  be- 
hind the  hand  of  the  surgeon  holding  them,  in  order  to  be  free  iii 
his  movements.  Then  making  first  a  simple  knot,  without  twist- 
ing the  thread,  and  tying  it  close  to  the  forceps,  he  then,  with  the 


Fig.  458.— Applying  the  Ligature. 


thumbs,  pushes  the  thread  further  along  the  artery,  and  ties  it  by 
pressing  the  thumbs  together  with  sufficient  firmness  to  rupture 
the  internal  membrane  of  the  vessel.  If  the  wound  be  deep,  in- 
stead of  the  thumbs  both  indexes  are  used  to  cany  the  thread 
along  the  artery  and  tie  it.     The  forceps  is  then  removed  and 


OPERATIONS    ON    THE    CIKCULATORY    SYSTEM, 


Fig.  460.— Improperly-made  Knot. 


a  second  straight  knot  is  made  (Fig.  459),  The  knot  represented 
in  Fig.  460  is  improperly  made  and  liable  to  become  loosened. 
The  extremities  of  the  thread  are  left  of  a  sufficient  length  to 
allow  their  being  turned  toward  the  most  dependent  part  of  the 
wound.  If  they  are  cut  too  short  they  are  liable  to  become  loose 
in  the  tissues,  and  be  covered  or  concealed  by  the  granulations  and 
become  the  center  of  a  suppurative  gathering.  Ligatures  intended 
to  remain  in  the  tissues,  must  be  made  of  animal  material. 

The  wound  of  an  artery  always  involves  the  application  of  a 
ligature  on  both  extremities  of  the  course,  the  central  and  the 
peripheric. 

Where  the  artery  cannot  easily  be  raised  or  dissected  from  the 
tissues  into  which  it  is  retracted,  the  pointed  tenaculum  can  be 
used  to  draw  it  out  of  its  position  ;  this  instrument  is  more  suita- 
ble for  small  than  large  vessels,  the  coat  of  which  it  is  liable  to  tear. 

In  the  immediate  ligating  of  an  intact  artery,  and  without  a 
solution  of  continuity,  the  vessel  is  exposed  by  means  of  an  in- 
cision, either  parallel  or  sometimes  oblique,  and  at  others  perpen- 
dicular to  the  artery,  according  to  its  situation  and  the  nature  of 
the  subjacent  tissues,  carefully  noting  any  projections  of  the 
bones,  muscles,  or  tendons  which  can  be  made  available  as  points 
de  repere;  observing,  indeed,  all  the  anatomical  connections  exist- 
ing between  the  different  structures.  When  the  artery  has  been 
nearly  reached,  in  order  to  avoid  injuring  it,  it  should  be  separated 
by  dissection  with  the  forceps  and  the  bistoury  from  the  tissues 
covering  it,  or  by  introducing  a  blunt,  grooved  director  under 
them,  as  a  guide,  and  dividing  them  with  the  knife.  The  sheath 
of  the  vessel  is  also  carefully  divided  and  separated  from  the  ves- 
sel itself,  which  is  then  carefully  isolated  from  its  vein  or  surround- 
ing adhesion,   and  the  blunt-eyed  tenaculum,  or  the    aneurism 


SUKGICAL    HEMOSTASIA.  537 

needle  passed  under  it.  Sometimes  this  is  easily  done,  but  in 
other  cases  the  density  of  the  connective  tissue  surrovmding  the 
artery  is  too  great  to  allow  the  needle  to  pass  readily  under  it, 
in  which  case  the  obstacle  can  be  removed  by  scraping  it  away 
with  the  finger-nail,  which  will  obviate  the  application  of  extra  trac- 
tion upon  the  vessel.  The  ligature  can  then  be  adjusted  around 
the  vessel  by  means  of  the  tenaculum,  and  the  operation  completed 
as  usual. 

(b)  Jlediate  Ligature. — This  operation  comprises  including 
in  the  ligature  of  the  vessel  a  certain  portion  of  the  surrounding 
tissue — a  portion  which  should  be  as  small  as  possible. 

It  is  done  with  a  curved  needle  and  a  Hgatui'e  of  single  or 
double  waxed  thread  or  silk.  The  needle  is  introduced  into  the 
thickness  of  the  tissues,  at  a  small  distance  from  the  artery,  and 
passed  around  it  with  the  ligature,  which  should  be  firmly  tied  in 
the  usual  way. 

The  ligature  is  quite  painful  in  consequence  of  the  pressure  it 
makes  upon  the  nervous  fibres  which  accompany  the  artery,  and  it 
is  less  safe  than  the  immediate  operation,  exposing  the  vessel,  dur- 
ing its  performance  to  the  risk  of  wounds  from  the  needle,  and 
requiring,  besides,  a  stronger  traction  upon  the  ligature  and  the 
knot,  from  the  increased  bulk  of  tissues  involved ;  and  there  is, 
again,  great  uncertainty  as  to  securing  a  sufficient  division  of  the 
internal  and  middle  coats  of  the  artery.  For  these  reasons  it  is 
less  adapted  to  large  than  to  small  arteries. 

The  effects  produced  by  the  application  of  a  ligature  are  not 
wholly  mechanical.  It  is  also  followed  by  certain  pecuHar  changes 
in  the  condition  of  the  vessel,  and  by  specific  inflammatory  phe- 
nomena which  result  in  the  permanent  obhteration  of  the  tubular 
character  of  the  artery. 

When  an  artery  is  tied  with  the  ligature  the  internal  and  mid- 
dle coats  of  the  vessel  are  also  divided  by  the  compressing  thread, 
and  by  their  retraction  above  and  below  it  they  form  a  double 
cone,  the  apices  of  which  rest  on  the  ligated  spot,  the  external 
coat  resisting  and  arresting  the  flow  of  the  blood.  A  clot  is  then 
formed,  and  the  ii-ritation  produced  by  the  pressure  of  the  ligature 
stimulating  the  proliferation  of  the  cellular  elements  of  the  walls 
of  the  vessel,  adhesions  are  soon  established  between  them  and 
the  coagulated  blood,  and  the  termination  is  the  solidification  of 
the  former  tube. 


538  OPERATIONS    ON    THE    CIRCTTLATORY    SYSTEM. 

Tlie  presence  of  the  Kgature  and  its  effect  on  the  surroundings 
of  the  blood  vessel  give  rise  to  a  process  of  elimination,  by  which, 
after  a  certain  time,  the  hgating  thread  is  expelled,  carrying  with 
it  the  vascular  stump  situated  beyond  the  Hgature.  At  the  same 
time,  and  while  these  phenomena  are  taking  place  outwardly,  the 
clot,  adhering  more  and  more  to  the  vasctdar  surfaces,  soon  be- 
comes the  seat  of  pecuhar  absorbent  changes,  and  gradually  dimin- 
ishing in  size,  at  length  disajopears. 

As  the  resorj)tion  of  the  clot  takes  place  the  walls  of  the  ves- 
sel contract  until  at  length  the  caHber  of  the  artery  becomes  en- 
tii'ely  obliterated,  and  the  former  tubular  canal  is  transformed  into 
a  fibrous  cord,  extending  from  the  point  of  the  ligature  to  the 
nearest  collateral  vessel. 

This  obliterating  process  of  the  arterial  canal  may,  however, 
be  defeated  by  the  interference  of  too  active  an  inflammation,  pro- 
ducing the  premature  sloughing  of  the  ligature,  or  by  the  exist- 
ence in  too  close  proximity  to  the  point  of  ligation  of  a  collateral 
arterial  branch.  In  both  cases  hemorrhages  may  follow ;  in  the 
first,  because  the  adhesion  of  the  clot  is  imjoerfect,  and  in  the 
second,  because  no  clot  has  been  formed. 

(C)  Torsion. — This  hemostatic  j^rocess  has  been  known  from  an 
early  date,  but  was  not  methodically  described  until  about  forty 
or  fifty  years  ago,  by  Amussat,  who  recommended  it  in  preference 
to  the  method  of  ligation.  But  daily  experience  has  demonstrated 
its  inferiority,  and  j)roved  it  to  be  a  less  powerful  hemostatic  meas- 
ure than  that  of  the  hgature,  and,  moreover,  that  it  is  only  avail- 
able for  hemorrhages  occurring  in  small  vessels. 

There  are  several  ways  of  aj^plying  torsion.  Among  the 
principal  is  that  recognized  by  Amussat.  It  requires  four  forceps, 
two  ordinary  anatomical,  another  whose  branches  are  terminated 
by  smooth  cylindrical  jaws,  and  the  fourth  the  artery-ttiyisting 
force2)s.  The  artery  is  held  with  one  of  the  ordinary  forceps ; 
with  the  other  the  tissues  surrounding  it  are  separated  from  it ; 
then  the  twisting  forceps  grasp  the  artery  at  its  extremity  in 
place  of  the  one  first  used,  keei^ing  it  out  of  the  wound,  and  when 
thus  secured  the  instrument  with  the  smooth  transverse  jaws  is 
applied  above  it,  close  to  the  tissues,  and  firmly  pressed  upon  the 
coats  of  the  artery.  In  this  position,  the  twisting  forceps  is  given 
a  rotary  motion  upon  its  axis,  as  if  the  vessel  were  to  be  rolled 
over  its  extremities,  and  is  twisted  upon  itself  by  seven  or  eight 


SURGICAL    HEMOSTASIA. 


539 


Fig.  461.— Artery  Forceps  for  Torsion. 

turns.  The  smooth-jaw  forceps  is  then  removed,  and  the  stump 
of  the  artery  is  released  and  pushed  into  the  tissues,  unless  the 
torsion  has  been  sufficiently  severe  to  produce  the  laceration  and 
retraction  of  the  vessel.  As  the  result  of  these  manipulations  the 
two  internal  coats  of  the  torn  artery  retract  upon  themselves  and 
the  external  coat  is  elongated  and  rolled  upon  itself — all  in  such 
a  manner  that  the  clot  is  arrested  by  the  retracted  internal  mem- 


540  OPERATIONS    ON    THE    CIRCULATORY    SYSTEM. 

branes,  as  well  as  by  the  support  contributed  by  the  pseudo-plug- 
ging,  which  results  from  the  twisting  of  the  external  coat. 

This  process  is  a  comphcated  one,  but  it  has  been  modified  in, 
several  ways.  In  one  process  only  two  ordinary  artery  forceps  are 
used ;  one  applied  at  some  distance  from  the  end  of  the  artery, 
transversely  to  its  axis,  and  the  other  holding  the  vessel  by  its  end 
in  continuity  to  its  length.  Keeping  the  first  tight  on  the  vessel, 
the  torsion  is  made  by  ten  or  twelve  complete  rotations  of  the 
second. 

Another  still  simpler  mode  consists  in  grasping  the  mouth  of 
the  bleeding  vessel,  and  giving  it  a  number  of  rotations  with  a 
strong  artery  forceps,  the  artery  being  thus  twisted  without  tear- 
ing or  entirely  dividing  it.  Nothwithstanding  all  these  modifica- 
tions, torsion  is  not  applicable  to  large  arteries,  and  cannot  super- 
sede the  ligature.  It  is  slower  in  performance ;  it  is  more  painful ; 
it  requires  a  greater  isolation  of  the  vessel ;  and  the  possibility  of 
untwisting,  and  with  it,  secondary  hemorrhage,  is  always  to  ba 
feared. 


CHAPTER  XI. 

OPERATIONS    ON   THE   NERVOUS 
SYSTEM. 

PLANTAR  NEUROTOMY. 

Altliough  the  word  neurotomy,  when  correctly  defined,  means, 
in  a  general  sense,  the  dissection  of  nerves,  it  has  In  surgery  an- 
other signification,  and  is  applied  indifierently  to  describe  the  di- 
vision, the  resection  or  the  amputation  of  a  nerve,  according  to 
the  special  manipulations  of  a  given  case.  In  veterinary  surgery, 
it  is  held  to  be  strictly  appUcable  to  the  operation  which  consists 
in  the  dissection  and  removal  of  a  portion  of  a  nerve,  and  as  the 
present  chapter  proposes  to  treat  princiiDally  of  affections  of  the 
foot,  it  is  simply  correct  to  employ  the  term  i^lantar  as  a  prefix  to 
the  title,  as  we  have  done.  The  design  of  the  operation  is  the 
destruction  of  the  susceptibility  of  the  region  or  organ  imphcated 
in  the  treatment,  and  to  subdue  the  pain,  if  not  permanently,  at 
least  for  a  period  of  time  sufficient  to  restore  a  working  animal  to 
his  ability  to  labor,  which,  without  such  a  relieving  operation, 
would  have  been  lost  to  usefulness  and  comfort. 

This  curious  and  important  operation  has  a  comparatively 
recent  history.  It  is  of  English  origin,  two  British  surgeons 
claiming  priority  in  its  performance.  These  rival  contestants  are 
Moorcrof t  and  Sewell,  who  put  it  in  practice,  the  former  in  India, 
and  the  latter  in  England,  at  about  the  same  time.  After  its  in- 
troduction, it  was  frequently  performed  by  EugHsh  veterinarians, 
among  whose  names  occur  those  of  Goodwyn,  Coleman,  Percivall, 
Sj)Ooner  and  others. 

Its  introduction  on  the  continent  was  in  France,  and  is  credi- 
ted to  Gu'ard,  Jr.,  who  described  it  in  1824,  and  from  that  date  it 
continued  to  be  a  subject  of  experiment  at  the  hands  of  many 
veterinarians.     We  say  ex])eri)iuut,  because  it  was  only  after  a 


542  OPERATIONS    ON    THE    NEEVOUS    SYSTEM. 

long  series  of  trials,  and  as  the  result  of  much  discussion  of  its 
merit  and  value,  that  it  secured  an  affirmative  verdict  from  the 
magnates  of  veterinary  practice,  and  became  an  estabUshed  posi- 
tion in  our  science.  Yet  the  objections  which  it  encountered  in 
Europe  have  not  to  this  day  been  wholly  eradicated,  and  on  this 
side  of  the  Atlantic  there  are  few  practitioners  who  still  decHne 
to  give  it  their  confidence  and  adopt  it  in  their  practice.  The 
opposition  which  it  has  encountered  is  founded  principally  upon 
the  failures,  the  accidents  and  the  unfortunate  sequelae,  which 
were  not  rarely  met  with  during  the  period  immediately  following 
its  original  introduction.  These  objections  we  now  proceed  to 
consider. 

Stumbling  has  been  mentioned  as  one  of  the  first  e£fects  of 
the  loss  of  the  tactile  function  of  the  foot,  by  the  destruction  of 
its  sensibility.  The  animal  which  has  lost  the  sohdity  and  the 
certainty  of  his  gait,  will  only  after  a  long  time  become  accus- 
tomed to  the  proper  use  of  the  comparatively  inert  mass  repre- 
sented by  so  indispensable  a  part  of  his  organization  as  his  foot, 
so  complicated  in  its  arrangements  and  adaptations,  and  so  per- 
fect a  portion  of  his  anatomical  structure  before  the  extirpation 
of  its  nervous  sense.  And  yet,  while  this  condition  of  stumb- 
ling must  be  fvilly  appreciated  by  those  whose  anatomical  knowl- 
edge enables  them  to  take  into  full  and  careful  consideration 
the  physiology  of  the  part,  and  who  have  verified  the  objection 
from  their  own  observation,  there  are  also  veterinarians  of  large 
practice  and  long  experience  who  have  operated  in  numerous 
cases,  even  upon  animals  used  for  fast  work,  where  the  muscular 
effort  is  of  a  comparatively  violent  character,  who  have  met  with 
the  accident  only  in  very  rare  and  strictly  exceptional  cases.  It 
must  rationally  be  inferred  that  an  unskilled  operation  of  such  a 
character  would  leave  the  patient  in  a  condition  of  which  an  awk- 
ward and  stumbhng  gait  would  be  but  a  natural  and  inevitable 
sign.  But  it  would  also  be  in  the  course  of  a  natural  and  healthy 
reaction  for  a  horse  to  educate  himself  rapidly  to  the  situation, 
and  acquire  a  new  certainty  of  movement  and  confidence  in  the 
use  of  his  feet,  which  would  soon  restore  him  to  his  former  abil- 
ity to  labor. 

The  casting  off  of  the  hoof,  as  a  compUcation  or  termination 
of  the  operation  in  neurotomized  horses,  is  one  necessarily  of  a 
fatal  character.     This  fataUty  has,  in  some  instances,  followed  the 


PLANTAK    NEUROTOMY.  543 

operation  within  a  period  of  from  one  to  two  months,  but  on  the 
other  hand  its  occurrence  has  been  deferred  in  other  animals  for 
jears.  Evidently,  these  varying  results  must  be  considered  as 
the  effect  of  different  and  quite  disconnected  causes.  The  truth 
is,  indeed,  that  in  the  first  instance  it  is  due  to  a  gangrenous  dis- 
organization of  the  tissues  within  the  foot,  and  in  the  second,  in- 
stead of  being  the  result  of  insufficient  vitality,  or  arising  from 
lack  of  nutrition  of  the  parts,  it  is  more  probably  the  consequence 
of  the  unregulated  force  of  the  concussion  when  the  foot  strikes 
the  earth — unregulated  because  of  the  loss  of  the  discriminating 
instinct  formerly  exercised,  but  now  lost  with  the  missing  nerve- 
oonsciousness  which  once  controlled  all  the  movements  of  the  limb. 
It  could  scarcely  happen  that  such  a  condition  of  things  should 
fail,  after  years  of  continuance,  to  encounter  some  susceptible 
temper  in  which  to  exhibit  its  baleful  influence. 

A  reason  which  must  not  be  oveiiooked  in  relation  to  the  cast- 
ing off  of  the  hoof  is  the  fact  that  in  the  neurotomized  animal 
the  essential  symptoms  of  the  first  development  of  any  lesions 
which  might  give  rise  to  it,  are  missing.  The  first  of  these  symp- 
toms is  the  pain  which  is  normally  manifested  by  the  lameness, 
and  for  that  reason  it  is  that  the  care  and  attention  required  by 
the  foot  of  a  neurotomized  horse  are  at  once  so  important  and  so 
commonly  overlooked  and  omitted.  But  without  ignoring  the 
possibility  of  this  accident,  the  question  is  presented,  whether  it 
is  of  such  common  occurrence  that  its  frequency  constitutes  a 
cogent  reason  for  abolishing  the  operation. 

Our  answer  to  this,  founded  on  the  showing  of  the  record, 
must  be  given  in  the  negative.  To  quote  but  one  among  many 
authorities — Professor  Nocard  says  that  out  of  more  than  one 
thousand  operations,  he  has  never  met  with  that  accident.  For 
ourselves,  in  a  practice  of  many  years,  with  a  number  of  neurot- 
omy cases  which  we  can  count  by  the  hundreds,  we  also  have 
never  encountered  it.  In  the  only  case  we  have  seen,  other  causes 
existed  in  the  form  of  suppurative  corns,  which  were  overlooked, 
and  which  were,  moreover,  comphcated  with  gangrene  of  the  vel- 
vety and  podophyllous  tissues. 

The  Softening  of  the  Perforans  Tendon  and  its  subsequent 
rupture,  is  also  a  very  severe  sequelae  of  neurotomy.  This  may 
take  place  almost  immediately  after  the  operation,  or  it  may  be 
postponed  until  after  a  few  months,  when  the  animal  has  resumed 


544  OPEKATIONS    ON    THE    NERVOUS    SYSTEM. 

Lis  work.  It  has,  indeed,  been  charged  to  undue  haste,  in  com- 
pelling- the  animal  to  labor  without  allowing  suificient  time  for  the 
healing  process  to  be  completed,  and  it  is  also  alleged  that  it  is  a 
consequence  of  the  performance  of  the  operation  on  both  sides  of 
the  leg  at  once.  It  is  both  a  possible  theory  and  a  plausible  argu- 
ment that  the  failure  of  the  tendon  is  the  result  of  the  shocks  in- 
flicted upon  it  while  in  a  condition  of  disease  and  unconsciousness, 
and  this  may  explain  the  possibihty  of  the  accident  without  any 
reference  to  the  circumstance  of  putting  the  animal  to  work.  But 
this  falls  far  short  of  proAing  that  the  neurotomy  exercised  any 
2)otent  agency  in  bringing  on  the  softening  and  rupture.  And  as 
to  the  effect  of  performing  the  double  simultaneous  operation,  our 
oj)inion  will  be  readily  inferred  from  the  fact  which  we  here  state, 
that  out  of  the  large  number  of  neurotomy  cases  which  have  passed 
through  our  hands,  we  have  seen  but  a  single  case  of  softening 
and  ruptiu'e  of  the  perforans  tendon,  and  that  was  associated  with 
a  fracture  at  the  os  pedis.  The  horse  had  been  operated  on  upon 
both  feet,  and  on  both  sides  at  once,  for  navicular  disease  of  old 
standing,  and  on  the  thu'd  day  following  he  was  found  in  his  box 
standing  on  both  fetlocks.  He  was  destroyed  and  it  was  found 
that  the  tendons  of  the  perforans  had  given  away  in  both  feet,  with 
a  fracture  of  the  navicular  bone  and  os  pedis  on  one  foot,  and  of 
the  OS  pedis  alone  at  the  semi-lunar  crest  on  the  other.  It  is  our 
constant  habit  to  operate  on  both  sides,  and  with  this  sole  excep- 
tion, we  have  never  met  with  softening  of  the  tendons. 

Springhalt. — Beugnot  and  Renner  report  cases  in  which  the 
performance  of  the  operation  on  the  hind  feet  was  followed  by  the 
appearance  of  springhalt. 

In  addition  to  the  points  we  have  been  discussing,  other 
alleged  objections  exist,  which  may  claim  superior  force  and  value, 
but  there  are  none  among  them  of  sufficient  weight,  in  view  of 
the  many  benefits  realized  from  the  operation,  to  justify  its  repu- 
diation and  abandonment. 

.Among  these  may  be  mentioned  the  theory  that  the  foot  de- 
prived of  its  sensibihty  by  neurotomy  is  more  exposed  to  the  se- 
quelae of  pricks,  contused  wounds,  corns,  etc.,  from  the  circum- 
stance that  there  is  no  betrayal  or  visible  manifestation  of  the 
lameness  which  is  usually  indicative  of  lesions  of  that  organ. 

It  is  further  objected  that  in  many  instances  the  lameness 
Khows,  sooner  or  later,  a  tendency  to  relapse.     But  there  is  httle 


PLANTAR    NEUROTOMY. 


545 


validity  in  this  allegation,  from  the  known  fact  that  in  a  majority 
of  cases  its  early  recun-ence  is  mainly  due  to  imperfect  methods  or 
an  vmskillfixl  performance  of  the  operation,  and  cannot,  for  that 
reason,  be  considered  a  proper  incident  of  the  case,  but  simply 
an  accident,  which  may  be  obviated  by  care  and  precaution,  and 
in  judging  the  transaction,  must  be  eliminated  from  the  argu- 
ment. 

Probably  the  most  important  and  most  nearly  valid  objection 
is  that  the  suppression  of  the  nervous  influence  has  more  or  less 
effect  upon  the  nutrition  of  the  digital  region.  Notwithstanding- 
the  observations  of  Braael,  the  question  of  the  direct  influence  of 
the  digital  nerves  upon  the  nutrition  of  that  region  is  a  point 
which  has  not  yet  been  thoroughly  comprehended  by  our  physiol- 
ogists. For  this  region  this  objection,  and  the  points  involved  in 
it,  call  for  further  study,  and  it  is  nearly  certain  that  when  it  has 
received  this  the  end  will  be  the  removal  of  the  reproach  brought 
against  neurotomy  of  interfering  with  the  vegetative  life  of  the 
digital  region. 

Having  thus  examined  the  objections  which  have  been  ui'ged 
against  neurotomy,  a  consideration  of  the  advantages  claimed  for 
it  will  come  next  in  order  of  mention.  Leaving  out  of  view  the 
few  failures  to  which  the  operation,  in  common  with  every  human 
act  or  endeavor,  whether  in  great  matters  or  small,  is  from  the 
constitution  of  things,  hable,  we  proceed  to  the  facts  which  demon- 
strate the  usefulness  and  value  of  the  treatment,  with  a  descrip- 
tion of  the  various  modes  of  procedure  practiced  by  different  sur- 
geons. The  facts  of  the  direct  and  successful  results  which  be- 
yond question  have  been  secured,  are  so  numerous  and  so  j)atent, 
and  they  so  far  counter-balance  all  possible  accidents,  that  no 
conceivable  array  of  abortive  cases,  if  reported  truly  and  with- 
out prejudice,  can  impair  their  force  and  significance.  It  would 
be  impossible  to  reach  even  a  proximate  estimate  of  the  value 
saved  and  the  loss  prevented  by  the  restoration  of  unnumbered 
useless  and  suffering  animals  to  comfort  and  usefulness. 

And  these  are  what  might  be  called  the  j^ositive  or  dii*ect  ad- 
vantages of  neui'otomy.  But  besides  these,  there  are  other  advan- 
tages in  the  secondar}^  effects  of  the  operation,  of  which  the  im- 
portance cannot  be  ignored,  especially  when  they  are  commended 
to  our  attention  by  such  authority  as  that  of  Professor  Nocard,  of 
Alfort,  when  he  says :  "  In  several  cases  I  have  noticed  a  great 


546  OPERATIONS    ON    THE    NERVOUS    SYSTEM. 

diminution  in  the  size  of  exostoses  (ringbones),  which  we  ti'eated 
bv  neurotomy ;  .  .  .  "  and  again,  "  Neurotomy,  by  removing  the 
jDain  existing  in  the  posterior  parts  of  the  foot,  removes  the  cause 
for  knuckling,  and  prevents  the  retraction  of  the  tendons  ;"  and 
further,  "  It  prevents  also  the  serious  accidents,  so  frequent  after 
firing  of  the  coronet,  sloughing  of  the  skin,  cartilaginous  quittor, 
necrosis  of  tendons  or  Hgaments,  opening  of  joints,  etc.,  all  being 
accidents  likely  to  follow  the  severe  cauterization  which,  to  be  suc- 
cessful, is  required  in  the  treatment  of  those  exostoses." 

Speaking  of  these  advantages,  Zundel  says :  "  In  rare  cases, 
besides  the  removal  of  the  lameness,  the  recovery  of  the  disease 
which  gave  rise  to  it,  may  also  be  observed.  Thus,  after  neuro- 
tomy, contracted  feet  have,  after  a  few  months,  regained  their  nor- 
mal form,  and  exostoses  have  stopped  their  growth  and  even  di- 
minished in  size." 

Having  thus  considered  this  matter,  both  pro  and  con,  giving 
on  one  side  the  objections  urged  against  it,  with  the  alleged  facts 
and  inferences  with  which  its  oj^ponents  seek  to  maintain  their  ar- 
gument, and  on  the  other  hand,  shown  the  reasons  which  influence 
the  friends  of  the  operation  in  advocating  and  putting  it  in  prac- 
tice, with  their  statement  of  its  utility  and  the  important  bene- 
fits it  is  capable  of  conferring,  we  are  prepared  to  examine  into 
the  conditions  which  indicate  or  counter-indicate  this  particular 
method  of  surgical  interference. 

Bouley,  speaking  of  its  indications,  said:  "When  the  digital 
region  is  the  seat  of  a  chronic  disease,  manifested  by  pain  and 
continued  lameness,  provided  the  alterations  of  structure  are  not 
of  such  a  nature  as  to  interfere  mechanically  with  the  execution 
of  the  function  of  the  region,  neurotomy  is  indicated."  And 
speaking  of  lameness,  the  seat  of  which  is  not  located,  Messrs. 
Hardy  and  Hugues  go  farther,  for  with  them  "  neurotomy  can  and 
ought  to  be  performed  when  a  lameness  from  an  unknown  cause, 
and  whose  nature  is  not  recognized,  has  for  a  period  of  more 
than  three  months  resisted  ordinary  therapeutical  and  surgical 
means." 

Taking  these  as  axiomatic  rules,  laid  down  by  such  authorities, 
and  substantiated  by  the  results  obtained  by  their  observance,  it 
becomes  evident  that  in  all  cases  of  lameness  of  the  nature  de- 
scribed by  these  writers,  or,  to  repeat,  lameness  and  pain  from  an 
unknown  cause,  neurotomy  is  the  indication,  and  if  it  fails  to  cure 


PLANTAR    NEUROTOMY. 


547 


tlie  imdiscovered  disease,  it  will,  at  least,  relieve  the  lameness,  if 
not  in  all,  yet  still  in  a  large  majority  of  the  cases. 

In  contraction  of  the  heels,  or  in  feet  subject  to  chronic  corns, 
as  result  of  their  conformation,  and  in  some  cases  of  chronic 
laminitis,  where  there  is  either  no  alteration  of  structure,  or  very 
little,  as  well  as  in  keraphylocele,  here  also  neurotomy  is  bene- 
ficial. But  it  is  principally  in  navicular  disease  that  its  advan- 
tages are  best  illustrated.  And  next  to  these,  as  best  adapted  to 
prove  and  exemj)hfy  its  benefits,  must  be  classed  ringbones  and 
sidebones,  the  characteristic  exostoses  of  the  digital  region. 

Excellent  results  have  followed  it  when  performed  for  the  rehef 
of  the  lameness  which  often  supervenes  upon  severe  injuries,  or 
operations  about  the  foot,  such  as  fractures  of  the  phalanges,  crush- 
ing of  hoof,  or  any  of  the  sometimes  violent  acts  of  surgical  inter- 
ference necessitated  by  the  diseases  of  that  region.  The  question 
has  even  been  discussed  of  the  probability  of  obtaining  beneficial 
results  in  tetanus,  following  traumatic  lesions  of  the  foot ;  especially 
in  punctured  wounds. 

A  glance  at  the  counter-indications  of  neurotomy  will  furnish 
a  plausible  explanation  of  the  objections  alleged  against  it  in  its 
earlier  history.  In  the  fact  that  the  complications  now  recognized 
as  thus  related  to  it  were  then  miknown,  and  consequently  un- 
recognized, and  the  operation  performed  notwithstanding,  we 
at  once  discovered  a  sufficient  reason  for  the  failures  and  bad 
results  of  the  treatment,  and  the  consequent' odium  into  which  it 
naturally  fell.  It  was  not  yet  adequately  comprehended — it  was 
misapplied — it  was,  perhaps,  unskilfully  performed — it  failed.  A 
very  logical  formula;  but  it  ought  not  to  have  been  denounced. 

Neurotomy  is  indicated  in  navicular  disease,  and  for  some  in 
the  very  iucipiency  of  the  attack,  all  other  modes  of  treatment 
being  only  palliative  and  temporary,  and  when  it  has  advanced  to 
its  chronic  stage  an  operation  will  be  of  Httle  advantage,  or  wholly 
unsuccessful,  if  at  this  period  the  bone  has  become  extensively 
diseased,  and  the  tendon  reduced  to  the  condition  of  a  mere  mem- 
braneous pellicle.  It  is  also  contra-indicated  in  all  forms  of  acute 
inflammation  of  the  foot ;  in  badly  formed  feet,  such  as  the  flat  or 
pumiced  of  chronic  laminitis  ;  and,  again,  when  the  lameness  origi- 
nates ia  a  very  large  exostosis  or  other  bony  disease  likely  to  be- 
come a  mechanical  obstruction  to  the  movements  of  the  articula- 
tion, or  to  the  play  of  tendons,  or  to  produce  anchylosis.  ,  To 


548 


OPERATIONS    ON    THE    NERVOUS    SYSTEM. 


resume,  it  may  be  said  with  Bouley,  "  one  must  not  ask  from  neu- 
rotomy more  than  it  can  grant,  by  applying  it  to  cases  where  the 
lameness  must  necessarily  persist,  even  after  the  removal  of  pain, 
in  the  diseased  parts." 

One  important  practical  point  in  the  performance  of  the  opera- 
tion is  the  determination  of  the  place  where  it  is  to  be  performed. 
A  reference  to  the  anatomical  disposition  of  these  plantar  nerves 
vsdll  aid  us  here.  In  the  forelegs  both  the  external  and  inter- 
nal plantar  nerves  form  branches  about  equal  in  size,  running  on 
each  side  of  the  leg,  with  an  identical  disposition.  Each  of  these 
nervous  branches  is  situated  along  the  tendon  of  the  perforans 


Fig.  462.— Plantar  Nerves  in  Digital  Region. 
P,  plantar  nerve;  A,  original  of  the  digital  nerves;  BBB,  cartilaginous  branch; 
C  C  C,  cutaneous  branch;  D,  digital  artery,  with  the  nerve  back  of  it;  E  E,  ramifications 
of  the  cartilaginous  and  cutaneous  branch ;   F  F,  bulbous  branches ;  G,  Transverse 
branches  back  of  the  fetlock  joint:  V,  digital  vein. 


PLANTAR    NEUROTOMY. 


549 


muscles,  then,  at  a  point  a  little  above  the  fetlock,  they  ramify 
and  divide  into  three  branches,  or  digital  nerves  proper ;  one  prin- 
cipal, posterior  or  continuation  of  the  main  trunk,  running  toward 


Fig.  463.— Plantar  Nerve  on  the  Posterior  Face  of  the  Phalanges. 
P.  plantar  nerve;  A,  origin  of  the  plantar  nerve  above  the  sosamoids;  B,  cartilagi- 
nous branch;  C,  cutaneous  branch;  D,  digital  artery;  II,  branch  to  the  cartilaginous 
bulbs— sometimes  absent;  I,  branch  of  the  plantar  cushion ;  K,  transversal  coronary 
branch;  M,  podophyllous  ramification;  O,  pre-plantar  nerve;  Q.  branch  to  the  patilobe 
eminence:  R,  arterial  branches;  V,  vein  which  is  sometimes  found  running  bacii  of  the 
plantar  nerve. 

the  middle  part  of  the  lateral  cartilage  of  the  foot,  under  which 
it  passes ;  a  second,  anterior,  smaller  than  the  posterior,  which  is 
divided  toward  the  middle  of  the  first  phalanx,  into  several 
branches,  ramifying  in  the  tendon  and  other  parts  of  the  anterior 
region  of  the  foot ;  and  a  thii-d,  or  middle  branch,  which  goes  to 
the  coronary  band  and  podophyllous  tissue.  The  consideration 
of  the  relation  held  by  these  plantar  and  digital  branches  to  the 
blood  vessels  constitutes  an  important  practical  point  in  the  opera- 
tion. Ai'tery,  vein  and  nerve  descend  on  both  sides  of  the  fet- 
lock, in  such  a  manner  that  the  vein  is  situated  in  front,  the  artery 


550 


OPERATIONS    ON    THE    NERVOUS    SYSTEM. 


in  the  middle,  and  the  nerve  behind — the  veia  being  on  a  plane 
somewhat  more  superficial  than  the  artery,  which  is  a  little  deej)er. 
Consequently  the  operation  may  be  performed  at  any  one  of  four 
points,  and  on  either  side  of  the  leg. 

These  are,  first,  above  the  fetlock,  on  the  plantar  nerve  proper ; 
second,  below  the  fetlock,  on  the  posterior  branch ;  third,  below 
the  fetlock,  also  on  the  anterior  branch ;  and  fourth,  according  to 
Nocard,  above  the  fetlock,  on  the  anterior  branch.  The  first  or 
second  of  these  locations  is  more  often  selected  for  the  operation^ 
and  forms  either  the  high  or  loio  process. 

For  each  of  these  operations  there  is  a  point  of  selection.  In 
the  high  process  this  is  immediately  above  the  fetlock,  where  the 
nerve  is  most  superficial  and  most  easily  exposed,  on  the  outside 
border,  and  a  little  in  front  of  the  perforans  tendon.  In  the  low 
method  it  is  below  the  fetlock,  in  the  middle  of  that  part  of  the 
coronet  region  where  a  depression  is  felt  between  the  tendon  and 
the  first  phalanx. 

The  question  of  preference  between  the  high  and  low  opera- 
tions has  been  made  the  subject  of  much  discussion,  and  it  re- 
mains still  unsolved.  With  many  the  high  operation  is  that  which 
yields  the  best  results;  others  hold  that  the  object  especially  con- 
templated in  any  given  case  must  determine  the  point  as  the  oc- 
casion presents  itself.  It  is  only  just  to  say,  however,  that  the  ma- 
jority of  practitioners  prefer  the  high  operation  ;  not  only  because 
it  is  easier  to  perform,  but  also  because  it  is  more  likely  to  be 
successful. 

Personally,  we  believe  that  the  high  operation,  with  some 
few  exceptional  cases,  is  that  which  will  prove  almost  generally 
beneficial. 

The  instruments  necessary  are,  a  pair  of  scissors,  a  convex 
bistoiuy  or  scalpel  (we  prefer  the  latter),  a  narrow,  straight  bis- 
toury, two  dissecting  forceps,  a  pair  of  blunt  tenaculums,  with 
an  elastic  band  (Fig.  464),  an  aneurism  tenaculum  (Fig.  465), 
needles,  thread  and  sponges.  Those  who  are  familiar  with  the 
operation  highly  commend  a  new  instrument,  the  neurotome  (Fig. 
466),  which  has  been  invented  to  take  the  place  of  the  straight 
bistoury. 

Neurotomy  is  a  simple  operation,  but  a  very  paiaful  one,  and 
it  is  necessary,  therefore,  to  have  the  animal  well  secured  from  the 
commencement  of  his  struggles,  which  may  endanger  both  himself 


PLANTAR  NEUROTOMY. 


551 


Fig.  464.— Blunt 
Tenaculum,  witli 
Elastic  Band. 


Fig.  465.— Blunt 
Tenaculum, 


Fig.  466.— Eight  and  Left  Neurotomes. 

and  the  surgeon  and  his  attendants.  We  fully  agree  with  the 
admitted  rule  that  animals  undergoing  surgical  operations  should 
be  thrown  and  properly  secured.  We,  with  other  practitioners, 
however,  have  succeeded  so  well  in  obtaining  complete  local  an- 
esthesia by  the  use  of  cocaine,  that  it  has  enabled  us  to  perform 
the  operation  in  the  standing  position.  We,  nevertheless,  can 
scarcely  see  the  necessity  for  general  anesthesia  when,  as  we  be- 
heve,  the  intense  pain  which  occm's  the  moment  of  the  division 
of  the  nerve  can  be  mitigated  by  careful  local  anesthesia  after  the 
nerve  is  exposed,  should  the  operator  think  it  necessary.  A  careful 
consideration  of  the  various  methods  recommended  for  securing 
an  animal,  when  cast  for  operation,  has  induced  us  to  adoj)t  the 
following  as  the  simplest,  the  safest  and  the  easiest  to  apply  and 
control:  The  animal  is  thrown  upon  the  side  of  the  leg  which  is 
to  be  operated  upon,  and,  both  legs  being  bound  together  above 
the  knee  with  a  few  twists  of  a  flat  rope  in  the  form  of  a  figure  8, 
the  leg  to  be  treated  is  removed  from  the  hobble  and  drawn 


552  OPERATIONS    ON    THE    NERVOUS    SYSTEM. 

forward  with  a  rope  attached  to  the  foot.  In  this  manner  the 
inside  of  the  leg  is  first  treated,  after  which  the  animal  is  turned 
over  and  the  process  repeated  on  the  outside.  If  the  operation  is 
to  be  performed  on  both  legs,  the  patient  may  be  thrown  on  either 
side  indifferent^,  and  his  legs  secured  as  before  described.  The 
under  leg  is  then  first  released  and  dealt  with  on  the  inside  ;  then 
rebound  to  the  hobble  and  the  upper  leg  liberated,  and  the  process 
repeated  on  the  outside.  The  horse  is  then  turned  over,  and  the 
inside  of  the  second  leg  oj^erated  upon  is  neurotomized  and 
returned  to  its  hobble  ;  and  finally,  the  uj^per  leg,  which  was  on 
the  under  side  at  the  beginning,  is  operated  on  uj^on  the  outside. 

Our  mode  of  operating  may  differ  somewhat  from  those  prac- 
ticed by  others,  but  the  general  plan  is  the  same. 

The  patient,  having  always  been  prepared  by  local  treatment 
of  his  fetlocks,  which  have  been  soaked  and  firmly  bandaged  for 
twenty-four  hours,  is  cast  and  secured,  as  before  stated,  the  hair 
is  closely  clipped  with  the  scissors,  and  the  parts  thoroughly 
washed  with  an  antiseptic  solution  (bichloride  of  mercury). 
Having  carefully  felt  for  the  location  of  the  nerve,  which,  in  many 
cases,  can  be  discovered  by  feeling  the  pulsations  of  the  artery, 
an  incision  is  made  through  the  skin  with,  if  possible,  one  stroke 
of  the  convex  bistoury,  measuring  from  an  inch  to  an  inch  and  a 
half  in  length.  It  is  an  advantage  to  have  the  incision  slightly 
obHque  to  the  direction  of  the  nerve.  Then,  with  a  f  orcej)s  in  one 
hand,  and  the  handle  of  a  bistoury  or  scaljpel  in  the  other,  the 
cellular  tissue  is  lacerated  from  the  edges  of  the  incision,  in  order 
to  allow  the  aj)plication  of  the  two  blunt  rubbered  tetiaculums, 
which,  when  in  position,  hold  open  the  wound;  or  sometimes 
threads  are  used  instead,  being  passed  through  the  edges  of  the 
wound  and  tied  on  the  opposite  side  of  the  leg.  If  the  incision 
has  been  made  in  the  proper  place,  after  sj)onging  away  the  trifling 
hemorrhage  w^hich  obscures  the  wound,  the  nerve  may  be  seen  at 
the  bottom,  or  it  may  be  found  surrounded  with  more  or  less 
condensed  cellular  tissue,  and  the  next  move  is  its  dissection. 
With  a  dissecting  forceps  in  each  hand,  we  firmly  grasp  the  con- 
nective tissue  with  one,  while  with  the  other  we  tear  it  away 
immediately  over  the  nerve,  removing  it  by  two  or  three  small 
portions  at  a  time  until  the  nerve  is  exposed,  lying  more  or  less 
closely  to  the  artery.  Then,  with  a  gentle  two-and-fro  movement, 
we  isolate   the   nerve    from   its  attachments   with   the   cellular 


PLANTAK    NEUROTOMY.  553 

structure,  and  when  it  is  loosened,  a  fact  easily  recognized  by 
an  apparent  shrinking  in  its  length,  it  is  ready  for  the  division. 
At  times  we  pass  under  it  the  blunt  aneurism  tenaculum,  carry- 
ing a  thread  with  which  to  secure  it,  and  when  secured,  passing 
the  pointed  bistoury  under  it,  we  divide  it  with  a  single  upward 
stroke  of  the  instrument.  In  other  instances,  instead  of  the  ten- 
aculum and  thread,  we  use  the  neurotome,  which,  having  a  curved, 
blunt  end,  enables  us  at  once  to  isolate  the  nerve,  and  with  a 
simple  motion  of  the  sharp  edge  to  divide  it  from  below  upward. 
Upon  making  the  section  the  lower  end  of  the  nerve  is  secured 
with  forceps,  drawn  out  of  the  wound,  separated  from  its  adhe- 
sions by  scraping  it  with  the  bistoury,  and  when  a  portion  about 
an  inch  or  an  inch  and  a  half  in  length  has  been  dissected,  and 
the  resection  is  completed,  either  with  the  neurotomy  knife  or  the 
bistoui-y,  the  wound  is  to  be  cleansed  with  antiseptic  washes. 

The  edges  are  in  a  very  few  instances  secured  by  a  stitch  of 
suture,  but  we  often  prefer  a  simple  antiseptic  dressing  and  a 
bandage. 

There  is,  of  com^se,  no  doubt  that  animals  will  often  struggle 
during  the  operation,  and  especially  at  the  moment  when  the  Uga- 
ture  is  tightened  upon  the  nerve,  or  when  the  nerve  is  divided, 
but  the  pain  in  either  case  is  so  transient  that  while  we  appreciate 
the  value  of  anesthesia,  we  cannot  recommend,  in  ordinary  prac- 
tice, general  etherization  or  chloroformization.  If  it  is  necessary 
to  have  recoiu'se,  as  some  do,  to  the  tourniquet,  or  of  any  other 
means,  to  control  a  possible  hemorrhage,  a  large  experience  in  the 
practice  of  this  operation  has  failed  to  show  us  a  single  case 
where  such  practice  would  have  been  of  advantage. 

The  various  details  of  the  operation  are  substantially  the  same, 
both  for  the  high  and  the  low  process.  It  must  be  borne  in  mind, 
however,  when  operating  below  the  fetlock,  that  the  nerve  is  often 
concealed  by  a  little  fibrous  band,  which  a  careless  operator  might 
mistake  for  the  Herve  itself. 

There  is  probably  no  special  attention  required  as  supple- 
mental to  the  operation.  The  wound  heals  more  or  less  rapidly 
by  first  or  second  intention,  and,  as  a  rule,  after  two  or  three 
weeks  there  are  no  signs  of  the  occurrence  excepting  a  simple 
linear  cicatrix  remaining.  Of  the  accidents  which  may  be  en- 
countered during  the  operation,  hemorrhage  is  the  most  import- 
ant.    Generally  this  is  referrible  to  an  error  on  the  part  of  the 


554  OPERATIONS    ON    THE    NERVOUS    SYSTEM. 

operator  in  dividing  the  artery  or  tlie  vein,  and  usually  it  is  not 
dangerous,  though  it  may  still  prove  very  troublesome.  If  the 
artery  is  divided  the  ligature  must  be  apphed  on  the  truncated 
ends ;  if  the  vein,  pressure  will  be  sufficient. 

The  last  important  point  involved  in  a  case  of  neurotomy  is 
the  length  of  time  required  by  a  neurotomized  animal  to  recuper- 
ate before  he  can  safely  return  to  his  work.  It  is  undeniable  that 
to  a  too  hasty  return  of  the  patient  to  his  accustomed  labor  most 
of  the  objections  and  alleged  complications  of  the  operation  may 
be  traced,  and  for  this  reason  the  answer  to  the  question  how 
long  a  rest  shall  follow  the  operation  must  be  as  long  as  circum- 
stances vyill  2>eTmit. 

Zundel,  Gourdon,  Fleming,  and  others,  make  a  month  the 
minimum  period  within  w^hich  no  considerable  exertion  should  be 
undergone ;  we  would  sometimes  be  still  more  liberal  in  allotting 
the  length  of  the  vacation. 


CHAPTER   Xn. 

OPERATIONS   ON    THE    GENITO-URINARY 
APPARATUS. 

CATHETERISM  OF  THE  URETHRA. 

The  object  of  this  operation  is  the  exploration  of  the  interior 
of  the  bladder,  and  consists  in  the  introduction  of  a  catheter, 
species  of  canula,  or  through  the  urethral  canal  into  that  organ, 
for  the  purpose  of  ascertaining  and  removing  its  contents.  Al- 
though the  urethra  of  the  male  has  great  length,  with  an  acute 
curve  at  the  ischial  arch,  the  operation  is  not  a  difficult  one.  It 
is  described  as  the  partial  and  the  complete,  according  to  the  dis- 
tance to  which  the  instrument  is  inserted  into  the  canal,  being 
partial  when  the  catheter  is  pushed  in  the  urethra  only  as  far  as 
the  pelvic  portion  of  the  passage,  but  complete  when  it  is  carried 
completely  into  the  bladder. 

The  operation  is  employed  in  animals  of  both  sexes,  and  is 
indicated  in  cases  of  retention  of  urine,  due  either  to  the  pressure 
of  calculi,  or  to  the  spasmodic  contractions  of  the  bladder,  which 
accompany  some  cases  of  colic ;  or,  again,  when  in  attacks  of 
paraplegia  the  animal  is  unable  to  micturate  naturally.  It  also 
constitutes  one  of  the  first  steps  of  the  operation  in  urethrotomy, 
in  cystotomy,  and  in  lithotrity. 

We  shall  consider  the  operations  separately  as  performed  in 
males  and  in  females. 

In  Males. — The  catheter  used  in  veterinary  practice  for  male 
solipeds  is  composed  of  a  tube  of  wire,  twisted  in  close  spirals, 
and  covered  with  a  species  of  thin  oil-cloth,  making  the  outer  sur- 
face perfectly  smooth,  and  forming  a  perfect  canula.  It  is  fur- 
nished with  a  stylet  made  of  flexible  rush  broom,  or  whalebone, 
which  can  be  readily  withdrawn  from  the  cavity  of  the  instru- 
ment. 

Metallic  catheters,  invented  first  by  Brogniez,  and  improved 
on  the  plan  of  those  used  in  human  medicine,  may  also  be  ob- 


556 


OPERATIONS    ON    THE    GENITO-UEINARY    APPARATUS. 


Fig.  467.— Catheter. 


tained,  but  they  are  not  in  as  general  use  as  the  simpler  and 
cheaper  kind  above  described.  India-rubber  instruments,  more 
or  less  pliable,  constructed  on  the  same  general  plan,  are  also 
made. 

In  solipeds,  urethral  catheterism  can  be  performed  either  when 
the  animal  is  standing  or  in  the  recumbent  position.  In  the  first 
case  he  is  kept  quiet  by  the  application  of  a  twitch  on  one  lij)  and 
of  the  hobbles  on  his  hind  legs.  This  done,  the  first  step  is  to 
secure  control  of  the  penis  by  drawing  it  out  of  the  sheath,  which 
must  first  have  been  thoroughly  cleaned  and  washed  to  remove 
all  the  sebaceous  secretion  which  by  its  greasy  consistency  renders 
this  step  of  the  operation  quite  a  difiiciilt  one,  many  animals 
resisting  the  attempt  to  accomplish  this  with  all  their  force.  But 
by  obtaining  and  retaining  a  firm  hold  of  the  penis  above  the 
glans,  and  drawing  upon  it  slowly,  firmly  and  steadily,  the  resist- 
ance of  the  animal  may  be  at  length  overcome,  and  the  organ 
brought  into  full  view.  The  operator  then,  guided  by  the  little 
protrusion  of  the  urethral  canal,  in  the  middle  and  a  little  toward 
the  lower  border  of  the  glans,  carefully  introduces  the  instru- 
ment, which  should  be  freely  lubricated  with  oil  or  vaseline, 
pushes  it  slowly  toward  the  ischial  arch.     When  the  instrimient 


CATHETEEISM  OF  THE  UEETHKA.  557 

reaches  the  ischial  space  the  stylet  must  be  withdrawn  in  order  to 
avoid  the  diiS&culty  of  bending  the  catheter  over  the  curve  formed 
at  that  point  in  the  urethra.  At  this  moment  a  gentle  but  firm 
and.  steady  pressure  upon  the  end  of  the  instrument  (easily  felt 
at  the  ischial  arch),  made  by  an  assistant  bending  it  forward,  will, 
with  a  little  careful  pushing,  effect  its  entrance  into  the  bladder. 
This  will,  of  course,  become  known  at  once  by  the  cessation  of 
the  resistance,  and  by  the  escape  of  the  urine  which  may  be  con- 
tained in  the  bladder. 

The  removal  of  the  institmient  is  effected  by  simply  drawing 
it  carefully  from  the  passage. 

Sometimes  simple  pressure  over  the-  ischial  arch  is  insufficient, 
and  the  bending  of  the  instrument  into  the  proper  direction  is  to 
be  made  through  the  rectum,  and  hence  the  indication  of  ha\dng 
that  organ  well  emptied  before  j^roceeding  to  the  oi^eration. 

The  indication  of  great  caution  in  this  operation  is  suggested 
by  a  consideration  of  the  fact  that  (if  the  canal  should  chance  to 
be  of  unusually  narrow  diameter  or  its  walls  softened  by  disease) 
there  is  sometimes  danger  of  forming  false  passages,  by  punctur- 
ing the  mucous  membrane,  and  forcing  the  catheter  into  the 
erectile  tissue  which  surrounds  the  urethra.  This  is  an  incident 
which,  however,  can  be  avoided  by  removing  the  stylet  from  the 
canula  before  its  introduction  into  the  urethra,  the  canula  itself 
being  terminated  by  a  j^erforated  oval  bulb,  perfectly  smooth,  and 
thus  incapable  of  inflicting  injury. 

In  Catheterizing  Females,  a  small  catheter  may  be  and  is 
sometimes  used,  but  as  a  rule,  the  metallic  instrument  is  prefer- 
able, the  conditions  of  the  method,  the  shortness  of  the  passage 


CT 


Fig.  468.— Female  Catheter. 


and  its  comparatively  large  diameter,  with  the  facility  with  which 
it  can  be  entered,  rendering  the  metallic  on  all  accoimts  more 
ehgible  than  the  composition  or  the  rubber  tube. 

The  instrument,  being  lubricated  with  oil  or  vaseline,  the  oper- 
ator, opening  the  vulva  with  the  left  hand,  introduces  his  right, 
holding  the  instrument,  into  the  vagina,  and  carries  it  forward  to 
the  meatus  urinarius,  which  he  can  feel  at  about  six  or  seven 


558  OPERATIONS    ON    THE    GENITO-UEINARY    APPARATUS. 

inches  in  front  of  the  vulva.  WhUe  thus  holding-  the  instrument, 
he  feels,  with  the  middle  finger  of  his  right  hand,  for  the  mucous 
valvular  fold  which  covers  the  meatus,  pushes  the  finger  under  it, 
and  then,  bringing  the  bulb  end  of  the  catheter  to  the  opening  of 
the  urethra,  inserts  it  into  the  bladder. 

The  accidents  that  may  arise  from  carelessness,  or  otherwise, 
in  the  catheterism  of  males,  are  not  met  with  when  treating 
females. 

UKETHKOTOMY. 

Incisions  of  the  urethral  canal  are  made  for  various  purposes. 
The  removal  of  foreign  bodies,  usually  calculi ;  the  restoration  of 
the  suspended  power  of  micturition  when  is  has  been  caused  by 
the  closure  of  the  passage ;  the  estabhshment  of  an  artificial 
urethral  opening  ;  and  the  penetration  of  the  cavity  of  the  bladder 
when  necessary  for  surgical  j)urposes — these  are  among  the 
reasons  for  which  this  important  canal  is  incised  by  the  surgeon. 
It  is  principally  performed  on  males,  the  dimensions,  aside  from 
its  shortness,  of  the  urethra  in  females  being,  as  a  rule,  ample, 
and  the  organ  sufficiently  dilatable  for  the  removal  of  calcuh, 
or  other  objects,  without  invohing  the  necessity  of  an  operation. 
Among  the  males,  the  ox  is  the  animal  which  most  frequently  re- 
quii-es  it,  by  reason  of  the  peculiar  Hability  of  this  animal  to  suffer 
from  a  constitutional  tendency  to  the  formation  of  calcuH  and 
the  fact  that  these  accretions  are  often  arrested  in  the  urethra,  in 
consequence  of  a  peculiar  double  curvature,  or  S  formation,  in  the 
penis. 

With  horses,  it  is  in  some  districts  quite  a  common  operation. 
In  these  animals,  however,  the  calculi,  though  of  rare  formation, 
are  larger  and  are  more  generally  retained,  either  in  the  bladder 
or  in  the  first  portion  of  the  urethra.  In  smaller  animals,  calculi 
are  also  quite  common  and  troublesome,  esj)ecially  in  dogs,  on 
account  of  the  presence  of  the  bony  formation  in  the  structure  of 
the  penis. 

In  the  horse,  the  principal  operation  is  performed  in  the  peri- 
neal region,  or  the  part  extending  on  the  median  hne  from  the 
anus  to  the  scrotum,  bounded  above  and  on  each  side  by  the 
ischial  tuberosities,  and  below  by  the  flat  of  the  thighs. 

The  skin  of  the  perineum  is  very  fine  and  thin,  and  is  hairless 


URETHROTOMY. 


559 


'  I  ifJitf  J  k 


Fig.  469.— Anatomy  of  the  Perineal,  Anal  and  Caudal  Regions. 
1 1.— The  skin.  2.— Portion  of  the  aponeurotic  sheath  of  the  coccygeal  muscles. 
S  3.— Inferior  eacro-coccygeal  muscles.  4  4.— Lateral  sacro-coccygeal  muscles.  5  5.— Is- 
chio-coccygeal  muscles.  6.— Suspensory  ligament  of  the  anus.  7  7.— Lateral  caudal 
arteries.  8.— Deep  caudal  vein,  satellite  of  the  median  artery.  9.— Median  caudal 
artery.  10  10.— Inferior  caudal  nerves,  li. -Lymphatic  glands.  12  13.— Superficial 
caudal  veins.  12'.— One  of  the  superficial  caudal  veins.  13.— Portion  of  the  perineal 
aponeurosis.  14  14.— Semi-membranosus  muscle.  15.— Sphincter  ani.  Kj  16.— Ischio 
cavernous  muscle.  17  17.— Bulbo  cavernous  muscle.  18  18.— Suspensory  ligaments  of 
the  penis.  19  19.— Bulbous  or  internal  pubic  arteries.  20.— luciaiou  of  the  urethral 
canal  for  urethrotomy.    21.— Anus. 


560  OPERATIONS    ON    THE    GENITO-tJRINAKY    APPARATUS. 

below  the  anus,  but  downwai'd  and  on  the  sides,  is  is  covered  with 
short  hau\  Below  the  skin  are  foimd  the  two  principal  layers  of 
aponeurotic  covering,  divided  into  the  superficial  and  the  deep. 
The  former,  of  fibro-elastic  texture,  is  the  continuation  of  the  dar- 
tos,  and  covers  the  perineal  region,  thinning  down  as  it  nears  the 
anus,  to  disappear  at  the  sphincter  ani.  Its  most  superficial  fibres 
give  attachment  to  a  subcutaneous  muscular  fasiculus,  which 
from  the  spHneter  ani  runs  downward  to  lose  itself  about  three 
inches  below.  The  latter  j)lane,  or  deep  aponeurosis  is  formed  of 
white  inextensible  fibrous  tissues.  Intimately  adherent  by  its 
external  face  to  the  superficial  layer,  it  covers  and  unites  with  the 
accelerator  urinae,  and  the  ischio-cavernous  muscles,  as  well  as 
with  the  suspensor  and  retractor  ligaments  of  the  penis.  It  then 
passes  between  the  ischio-cavernous  and  the  semi-membranosus, 
to  attach  itself  above  on  the  ischial  tuberosity  and  become  lost 
downward  on  the  thighs.  Some  of  its  fibres  directly  surround 
the  fixed  portion  of  penis,  and  join  the  aponeurosis  common  to 
all  the  muscles  of  the  flat  of  the  thigh. 

The  sus23ensor  and  retractor  of  the  penis  form,  in  the  upper 
perineal  region,  that  is,  from  the  anus  to  the  ischial  arch,  an  ex- 
pansion of  sufficient  width  to  form  a  true  anatomical  layer.  Below 
this  they  represent  bands  about  half  an  inch  wide,  situated  on  the 
median  line,  and  covering  the  accelerator  muscle.  They  are 
formed  of  white  muscular  fibres.  The  blood-vessels  and  nerves 
of  this  region,  with  the  other  parts  pertaining  to  the  anatomy  of 
the  urethra,  have  already  been  considered. 

The  pecuUarity  that  belongs  to  the  penis  of  ruminants  must 
not  be  overlooked,  when  the  question  of  urethrotomy  in  these 
animals  is  under  discussion.  Their  penis  is  very  long  and  thin,  and 
is  surrounded  in  the  perineal  region  by  a  complete  aponeurotic 
sheath,  and  on  a  level  with  the  pubis  it  has  two  curvatures,  which 
give  to  the  organ  the  form  of  an  S.  On  a  level  with  the  second 
curvature  it  gives  attachment  to  the  suspensory  ligaments.  The 
free  portion  of  the  organ  is  elongated,  strongly  fihform,  and 
covered  by  a  fine,  rosy  mucous  membrane.  The  peculiarities 
possessed  by  the  penis  of  the  horse  do  not  exist  in  cattle. 

The  operation  of  urethrotomy  is  classified  and  designated  with 
reference  to  the  part  of  the  urethra,  which  is  to  be  divided,  and 
this  is  of  course  determined  by  the  location  of  the  body  to  be  re- 
moved, making  the  designations  principally  regional;  and  it  is 


UEETHROTOIMT. 


561 


therefore  said  tliat  the  operation  can  be  performed  in  three  ways, 
though  three  places  would  be  the  more  accurate  phrase. 

Thus  we  have  first,  the  incision  at  the  point  of  the  penis,  or 
preiyutial  urethrotomy  y  second,  the  division  in  the  scrotal  region, 
or  scrotal  urethrotomy ;  and  third,  the  incision  below  the  anus, 
or  ischial  urethrotomy. 

Preputial  Ueetheotomy. 
In  horses  and  dogs  the  urethra  becomes  more  or  less  con- 
tracted toward  the  full  extremity  of  the  penis,  and  calculi  are 
therefore  apt  to  become  arrested  in  that  locality  ;  in  other  cases, 
masses  of  sebaceous  matter  will  collect  in  the  navicular  fossa.  In 
sheep,  saline  concretions  are  found,  either  in  the  prepuce  or  in  the 
urethra.  All  these  conditions  involve  a  contingency  of  surgical 
interference.  To  remove  them  in  the  horse  and  in  dogs,  a  trans- 
verse incision  is  made  with  a  bistoury  over  the  spot  where  the 
presence  of  the  foreign  body  is  detected,  and  it  is  readily  disposed 
of.  If  the  erratic  substance  is  in  the  urethra,  an  incision  is  made 
through  its  membranes  and  it  is  removed  in  entirety,  or  sometimes 
after  having  been  reduced  to  fragments  by  means  of  a  probe  or 
of  a  curator.  In  sheep,  the  simple  amputation  is  recommended 
by  some.     The  wound  made  in  these  cases  heals  without  trouble. 

Scrotal   Urethrotomy. 

Scrotal  urethrotomy  ean  be  performed  either  on  the  front  or 
behind  the  testicles.  In  cattle  it  is  ordinarily  posteriorly  that  the 
calculus  is  lodged,  more  commonly  in  the  second  than  in  the  first 
curvature,  and  hence  the  indication  for  selecting  this  place  for  the 
operation.  Yet  there  are  practitioners  who  j)refer  the  anterior  sec- 
tion, because  the  penis  being  more  superficial  at  that  place,  there 
is  less  cellular  and  adipose  tissue  to  be  divided  before  exposing  it. 

In  either  case,  the  animal  is  thrown,  with  the  hind  leg  carx'ied 
forward  and  secured  as  for  castration.  If  the  operation  is  to  be 
performed  behind  the  testicular  mass,  an  incision  is  made  on  the 
median  Une,  measuring  about  three  inches  in  length,  the  cellular 
tissue  divided  with  the  knife  or  the  finger  and  the  penis  drawn 
out  through  the  incision.  The  calculus  is  extracted  through  a 
longitudinal  incision.  The  canal  should  then  be  examined  with  a 
probe  or  bougie,  to  ascertain  whether  any  more  ofi'ending  bodies 
are  present,  and  if  so,  they  are  of  course  also  removed.     The 


5G2  OPERATIONS    ON    THE    GENITO-UEINAKY    APPARATUS. 

wound  may  be  either  closed  by  sutures,  or,  preferably,  left  without 
interference,  to  obviate  the  possible  danger  of  the  formation  of 
future  scrotal  abscesses. 

In  the  pre-scrotal  oj)eration,  the  hair  is  first  clipped  short,  and 
an  incision  made  through  a  transverse  fold  of  the  skin,  to  expose 
the  penis.  The  concluding  steps  are  the  same  as  those  in  the 
former  case. 

It  is,  however,  always  advisable,  when  the  animal  is  secured, 
and  before  dividing  the  tissues,  to  insert  the  hand  into  the  pre- 
puce to  draw  out  the  organ.  By  thus  straightening  it  and  remov- 
ing the  S  curvature,  it  is  possible,  and  sometimes  occurs,  that 
calculi  are  displaced  and  extracted  without  the  necessity  of  resort- 
ing to  the  knife. 

The  urinary  fistixlas  which  are  among  the  sequelae  of  scrotal 
urethrotomy,  are  of  two  or  three  weeks'  duration,  seldom  continu- 
ing longer.  Care  must  be  taken  to  protect  the  skin  from  the 
irritation  produced  by  the  dripping  of  the  urine  through  the 
wound. 

Ischial   Urethrotomy. 

This  is  the  most  common  of  the  three  operations,  and  is  appli- 
cable to  all  males. 

It  is  performed  without  casting,  with  the  animal  hobbled  on 
both  hind  legs  and  a  twitch  on  his  lip.  (Fig.  470.)  The  decubi- 
tal position  is  seldom  required.  The  free  use  of  cocaine  has 
enabled  us  to  operate  without  any  means  of  restraint,  not  only  in 
horses,  but  in  camels,  which  are  very  awkward  and  uneasy  animals 
at  the  best,  and  esjoeciaUy  when  in  the  hands  and  under  the  knife 
of  the  surgeon.  The  insertion  of  a  catheter  has  been  recom- 
mended by  many,  to  serve  as  a  guide  to  the  dissection  of  the 
urethra,  while  others  prefer  the  artificial  dilatation  of  the  canal 
by  the  injection  of  water.  In  some  cases,  however,  neither  of 
these  expedients  is  necessary.  The  presence  of  the  calculus  and 
the  dilatation  of  the  urethra  above  it,  by  the  confined  urine, 
greatly  assists  in  the  location  and  puncture  of  the  canal. 

The  incision  must  be  made  on  the  main  line,  on  a  level  with 
the  ischiatic  arch.  The  structures  to  be  divided  are  first,  the 
skin,  then  the  subcutaneous  cellular  tissue,  the  aponeurotic  layers, 
and  the  accelator  urinae;  which  being  completed,  a  straight 
puncture  can  be  made  in  the  urethra  between  the  two  suspen- 
sory ligaments.     The  incision  is  then  extended  upward  or  down- 


URETHROTOMY. 


563 


Fig.  470.— Secure  for  Ischial  Urethrotomy. 

ward,  as  may  be  required,  with  the  bistoury,  guided  by  the 
grooved  director,  a  blunt  bistoury  being  sometimes  chosen  from 
the  motive  of  prudence,  in  order  to  avoid  possible  injury  to  the 
surrounding  blood  vessels. 

In  our  experience  we  have  secured  very  satisfactory  results  by 
adopting  the  method  recommended  by  Boiiley,  of  making  one 
comprehensive  pimcture,  which  penetrates  the  canal  without  any 
preUminary  dissection  of  the  incumbent  parts,  especially  when  a 
catheter  has  been  placed  in  the  ui'ethra  for  the  guidance  of  the 
knife.  The  hemorrhage,  which  generally  accompanies  this  mode 
of  operation  is  of  no  great  importance,  often  subsiding  of  itself, 
and  seldom  requmng  external  hemostatic  appHcations. 

"NVe  believe  it  to  be  the  better  coiirse,  when  the  object  in  view 
has  been  realized,  to  leave  the  wound  to  itself,  without  interfering 
with  the  healing  process  by  seeking  to  facilitate  it  by  the  appHca- 
tion  of  sutures.  It  gradually  granulates  and  closes  without  any 
special  care  beyond  the  observance  of  cleanHness  and  the  neces- 
sary measures  to  prevent  irritation  of  the  skin  from  the  contact 
of  the  urine  as  it  "leaks  "  through  the  wound. 

When  the  urethra  has  been  opened,  in  whatever  region  of  the 
penis  the   offending  foreign  body  may  be  lodged,  it  is  readily 


564 


OPEEATIOXS    ON    THE    GENITO-UKINARY    APPARATUS. 


15     I'tt 


Straight.  Curved. 

Figs.  471,  472.— Forceps  to  remove  Foreign  Bodies  from  the  Bladder. 

extracted  witli  straight  or  curve  forceps.  These  can  also  be  em- 
ployed to  secm-e  those  of  comparatively  small  size  that  may  be 
foimd  in  the  bladder,  and  answer  very  well  Hkewise  for  those 
masses  of  a  sedimentary  nature  that  are  commonly  seen  in  mares. 

There  may  sometime  be  some  peculiar  pathological  conditions 
which  render  it  necessary  to  prevent  the  closing  of  the  woimd  in 
cases  of  ischial  urethrotomy,  and  when  the  formation  of  a  perma- 
nent artifical  opening  should,  perhap,  be  attempted. 

The  entu-e  closing  of  the  urethra,  in  its  anterior  portion,  re- 


URETHROTOMY. 


565 


suiting  from  some  siDecial  trauma^ 
tism  woiild  be  such  a  case ;  or  again, 
when  the  formation  of  calcuH  has 
become  an  estabUshed  constitutional 
habit,  and  the  results  of  this  perver- 
sion of  the  nutritive  and  assimilative 
function  are  always  present  and  con- 
tinually renewed.  In  view  of  this 
amfortunate  state  of  things,  and  to 
prevent  the  closing  of  the  woxmd, 
Troeber  recommends  the  use  of  a 
pecuhar  tube,  which,  when  intro- 
duced into  the  urethra  can  be  per- 
manently retained  in  place  for  an 
indefinite  length  of  time  (Fig.  473), 
We  have  attempted  the  formation 

of  an  artificial  urethral  opening,  by    Fialk-Tube  of  Troeber,  for  iscuial 
sewing  together  the   mucous  mem-  Urethrotomy  in  Bovines. 

brane  of  the  canal  and  the  skin,  but  the  results  of  the  experiment 
were  of  the  most  transient  character. 


CYSTOTOIHY. 

Improperly  knowTi  also  as  lithotomy,  is  an  operation  which 
consists  in  the  incision  of  the  neck  of  the  bladder  to  remove  cal- 
culi of  dimensions  too  great  for  removal  intact  through  the 
urethra.  This  operation  has  no  longer  a  place  in  our  surgery, 
and,  in  fact,  there  is  no  existing  reason  for  its  performance.  If  a 
calculus  is  of  small  or  of  medium  size  the  neck  of  the  bladder 
can  always  be  sufficiently  dilated  to  permit  its  passage,  and  if  it 
should  be  of  greater  dimensions,  and  rendered  impossible  of  ex- 
traction by  its  size,  the  operation  of  Hthotrity  is  always  available, 
and  in  experienced  hands  as  nearly  certain  and  safe  as  can  reason- 
ably be  expected. 

LITHOTEITY. 

This  term  designates  the  operation  of  crushing,  or  piercing, 
or  drilling  stones  in  the  bladder,  in  order  to  reduce  them  to  frag- 
ments, preparatory  to  then-  removal  by  means  of  forceps  or  cur- 
ates, or  by  washing  them  out  of  the  bladder  with  water.  It 
mostly  corresponds  with,  or  rather,  includes  the   Uthotomy  of 


566 


OPEKATIONS    ON    THE    GENITO-URINARY    APPARATUS. 


Fig.  474.— Lithotritor  of  Guillon. 


human  surgery.  It  was  per- 
formed for  the  first  time  by 
H.  Bouley  in  1858,  with  the 
'  assistance  of  a  practitioner 
of  human  surgery,  Dr.  Guil- 
lon. 

Horses  are  more  specially 
the  subjects  of  this  opera^ 
tion  in  cases  when  the  cal- 
culi are  too  bulky  and  too 
hard  to  be  broken  and  re- 
moved with  the  forceps 
alone.  In  ruminants,  on 
the  contrary,  vesical  calculi, 
though  more  common,  and 
more  numerous  in  single 
animals,  are  generally  of 
sufficiently  small  size  to 
permit  the  relief  of  the  pa- 
tient by  the  simple  opera- 
tion of  m-ethrotomy. 

The  instruments  neces- 
sary for  this  operation  are 
the  lithotritor,  or  lithon- 
trijytor,  with  also  the  crush- 
ing forceps.  The  lithotri- 
tor of  GuiUon  (Fig.  474), 
or  the  crushing  forceps  of 
Bouley  (Fig.  475),  are  those 
generally  used.  We  are  con- 
vinced by  our  experience  of 
these  instruments  that  the 
^.  principal,  and  probably  the 
only  objection  that  apphes 
to  them  lies  agamst  their 
mechanical  construction. 
We  consider  them  to  be  too 
clumsy,  too  large  and  too 
heavy;  objections,  howevei", 
which  are  ver-y  easily  ob\d- 


LITHOTKITY. 


567 


ated  by  any  competent  instru- 
ment-maker. 

"WTiile  they  must  necessa- 
rily possess  sufficient  power  to 
crush  the  calcuH,  we  fail  to  see 
that  a  proper  attention  to  the 
features  of  symmetry,  finish, 
and  convenience  of  manipula- 
tion can  involve  any  sacrifice 
of  efficiency.  The  instrument 
can  be  made  to  possess  amjole 
strength,  while  still  more  easy 
to  handle  when  iutroduced  in- 
to the  bladder  through  the  com- 
paratively small  opening  of  is- 
chial urethrotomy. 

A  bivalve  speculum  (Fig. 
476)  to  dilate  the  wound  of  the 
urethra  is  sometimes  of  great 
value.  A  large  syringe,  and 
plenty  of  water,  or  what  is 
better,  an  irrigator  for  douches 
to  wash  out  the  bladder,  will 
complete  the  series  of  neces- 
sary instruments.  The  opera- 
tion is  performed  with  the  ani- 
mal in  the  standing  position, 
secured  as  for  urethrotomy,  or 
cast  if  the  operator  so  prefer 
it,  and  placed  under  the  influ- 
ence of  general  anesthesia. 

We   borrow  from  H.   Bou-       FM- 475. -Crushing  Forceps  of  Bouley. 
ley,  the  father  of  the  operation,  his  own  description  of  the  modus 
operandi : 

Access  to  the  bladder  having  been  obtained  by  the  process 
ah-eady  described,  the  essential  operation  is  di\ided  into  three 
principal  steps  : 

1st.  The  introduction  of  the  hthotritor,  and  searching  for  and 
grasping  the  stone ;  2d,  crushing  of  the  calciilus ;  3d,  removal  of 
the  fragments. 


508  OPERATIONS    ON    THE    GENITO-URINAKY    APPARATUS. 


Fig  476.— Bivalve  Speculum. 

1st.  Introduction  of  the  instrument  for  searching  and  grasp- 
ing the  stone. — This  step  varies  with  the  instrument,  as  to  whether 
the  lithotritor  or  the  crushing  forceps  is  used.  If  the  first,  the 
instrument,  well  greased  and  kept  closed,  is  inserted  through  the 
urethral  incision,  with  its  concavity  resting  on  the  convexity  of  the 
ischial  arch,  and  is  pushed  obliquely  forward  and  downward 
through  the  pelvic  portion  of  the  urethra  and  the  neck  of  the 
bladder.  When  in  this  cavity  the  branches  of  the  instrument  are 
opened,  and  by  a  sHght  and  slow  movement  made  to  traverse  the 
cystic  space  until  it  comes  in  contact  with  the  calculus,  which  then 
drops  into  the  hollow  of  the  branch  adopted  by  its  shallow  form 
to  receive  it.  The  jaws  of  the  instrument  are  then  brought  to- 
gether and  the  stone  firmly  secured. 

The  same  description,  in  every  particular,  appHes  to  the  ma- 
nipulation of  the  crushing  forcej^s. 

In  some  cases,  however,  it  is  necessary  to  disarticulate  the  in- 
struments, and  to  introduce  the  branches  separately,  imiting  them 
when  both  have  been  inserted. 

It  is  important,  in  every  case,  to  leave  a  small  portion  of  urine 
in  the  bladder  to  facilitate  the  movement  of  the  stone  and  aid  in 
its  seizure  vrithout  grasping  and  pinching  the  lining  membrane  of 
the  organ.  If  the  bladder  is  empty  a  portion  of  water  might  be 
injected. 

2d.  Crushing  of  the  Stone. — This  is  done  by  slowly  approxi- 
mating the  jaws  of  the  instrument.  It  is  not  necessary  to  reduce 
the  stone  to  very  minute  particles.  It  will  be  sufficient  if  their 
dimensions  are  not  too  great  to  permit  their  free  escape  through 
the  urethral  passage. 

In  removing  the  instrument  after  accompHshing  the  crushing, 
a  great  deal  of  the  comminuted  calculus  is  extracted  between  its 
jaws.  , 

3d.  Removal  of  the  Fragments. — Dilatiug  the  urethral  wound 


LITHOTKITY.  569 

witli  the  bivalve  speculum,  a  stream  of  water  is  then  thrown  into 
the  bladder,  either  with  the  syringe  or  the  tube  of  the  irrigator. 
The  water  ought  to  be  tepid  and  antiseptic ;  and  a  hand  intro- 
duced into  the  rectum  and  manipulating  the  bh^dder,  will  facHi- 
tate  the  repulsion  of  the  larger  fragments,  and  the  washing  out  of 
the  smaller.  The  general  attention  required  in  all  cases  of  serious 
operations  will  be  necessary  after  the  performance  of  lithotrity. 
In  respect  to  any  special  dressing,  they  are  the  same  as  those  in- 
dicated in  simple  urethrotomy. 

Serious,  however,  as  this  operation  is,  it  is  comparatively  free 
from  dangerous  sequelae.  Hemorrhages  of  easy  control  have  been 
met,  TU'iaary  abscesses,  with  infiltration,  have  occurred,  serious 
wounds  of  the  urethra,  of  the  rectum  and  of  the  bladder  may  also 
happen,  but  they  are  of  rare  occurrence,  and  can  be  avoided  by 
careful  manipulation  through  all  the  steps  of  the  operation. 

AMPUTATION  OF  THE  PENIS. 

This  operation  is  indicated  in  the  horse  when  the  penis  becomes 
the  seat  of  warty  growths;  of  epithelial,  papillomatous,  or  can- 
cerous degenerations  ;  of  fractture ;  of  paraphymosis,  or  of  paraly- 
sis. Warty  growths  are  usually  found  covering  more  or  less  the 
free  part  of  the  penis ;  or  its  free  extremity;  or  the  glans  penis; 
and  are  also  sometimes  met  with  on  the  inside  of  the  sheath,  their 
presence  being  accompanied  with  an  ofifensive  and  very  irritating 
sebaceous  discharge,  becoming  at  times  so  painful  as  to  interfere 
with  micturition.  They  resist  the  severest  forms  of  treatment, 
and  it  is  not  unusvial  for  theDQi  to  develop  into  forms  of  a  more 
alarming  nature,  notably  those  of  chancroid  degeneration,  of 
which,  in  fact,  these  epithilial  growths  are  but  the  seminal  origin. 
In  other  cases  the  erectile  tissue  of  the  glans  penis  becomes  the 
seat  of  idceration,  extending  in  depth,  spreading  in  such  a  manner 
over  the  penis  that  the  free  portion  of  the  organ  becomes  a  mere 
mass  of  bleeding  surface,  of  irregular  asjject,  macerating  in  the 
pus  which  abimdantly  forms,  and  which  escapes  with  its  pecuUarity 
of  bloody  saniousity,  with  the  most  repulsive  odor  and  irritating 
effect,  rendering  the  act  of  micturition  most  painful  and  difficult. 
In  many  instances  the  animal  so  dreads  to  bring  his  j^enis  out  of 
the  sheath  that  he  urinates  within  the  ca\aty  formed  by  the  folds 
of  the  skin,  adding  another  soui-ce  of  irritation  to  that  ak-eady 


570  OPERATIONS    ON    THE    GENITO -URINARY    APPARATUS. 

existing.  And  if  the  penis  is  still  allowed  to  pass  out  of  the 
sheath,  the  inictm'ition  is  made  with  a  crooked  stream,  which  in- 
stead of  escaping  forward  is,  on  the  contrary,  discharged  back- 
ward. In  such  a  case  no  treatment  will  reheve  the  difficulty  but 
the  removal  of  the  entire  diseased  structirre. 

In  fractures  of  the  penis  ;  in  many  conditions  of  paraphymosis ; 
or  in  those  of  paralysis,  the  organ  hangs  suspended  outside  of  the 
sheath,  and  cannot  be  restored  to  its  cavity.  If  pushed  back  it 
soon  returns  to  its  abnormal  condition,  and  even  if  retained  by 
artificial  means,  will  continue  in  place  only  while  the  means  are 
continued  to  enforce  it,  becoming  displaced  agaia  whenever  the 
restraining  agency  ceases  to  operate.  This  serves  to  render  the 
animal  useless,  in  consequence  of  its  appearance  being  so  repul- 
sive as  to  preclude  his  employment  in  public  view.  Of  course  the 
only  radical  cure  for  such  an  ailment  is  the  knife  or  its  equivalent. 

The  operation  usually  consists  in  the  removal  of  the  free  por- 
tion of  the  penis,  the  necessity  for  going  beyond  this  seldom 
occurring,  yet  in  order  to  reach  the  diseased  part  it  is  sometimes 
necessary  to  divide  the  sheath  along  the  median  line. 

The  general  anatomy  of  the  organ,  as  far  as  it  relates  to  the 
operation,  is  very  simple.     The  penis  it  formed  by  the  corpus 


Pig.  477.— Penis  in  Normal  Condition. 

cavernosum,  a  long,  erectile  structure,  flattened  from  side  to  side, 
and  grooved  on  its  inferior  border  for  the  reception  of  the  corj)us 
spongiosum  urethi'se.  Terminated  inferiorly  by  a  blunt  point, 
this  corpus  cavernosum  dips  into  the  erectile  tissue  of  the  urethra- 
After  passing  out  of  the  pehic  cavity,  by  the  ischial  arch,  the 
spongious  portion  of  this  canal,  is  received  into  the  groove  of  the 
corpus  cavernosum,  at  the  anterior  part,  and  also  extends  beyond 
it.     The  mucous  membrane  is  covered  externally  by  the  tissue 


AMPUTATION    OF    THE    PENIS.  571 

which  gives  to  this  part  of  the  urethra  its  name,  and  this  erectile 
tissue  terminates  anteriorly  in  an  enlargement,  more  or  less 
developed,  forming  the  head  of  the  penis,  or  the  glans  penis. 
The  urethra  proper  protrudes  a  little  below  the  center  of  the 
head  of  the  penis,  and  shows  in  a  cavity  undei-neath,  the  lurethral 
fossa,  more  or  less  filled  with  a  sebaceous  secretion.  The  blood 
vessels  which  ramify  in  these  erectile  structures  are  the  two  dor- 
sal arteries  of  the  penis,  anterior  and  posterior,  and  the  veins, 
which  form  large  branches,  running  also  upon  the  dorsal  border 
of  the  organ. 

Zundel  very  wisely  insists  upon  two  principal  conditions  (to 
which  we  shall  again  refer)  to  reahze  in  the  operation,  ^Vs^  to 
manage  to  leave  a  free  means  of  exit  for  the  luine,  by  cutting 
away  less  of  the  urethra  than  that  of  the  cavernous  body,  and 
seco7id,  to  avoid  the  hemorrhage,  which  is  especially  liable  to  take 
place  in  horses,  on  account  of  the  abundant  circulation  in  the 
erectile  tissues. 

The  animal  if  to  be  placed  in  the  recumbent  position,  as  in  the 
operation  for  castration,  that  is,  on  the  left  side ;  or  it  may  prove 
advantageous  to  place  him  on  his  back. 

Five  modes  of  operation  are  described  by  different  writers  on 
the  subject — 1st,  the  ligature;  2d,  cauterization;  3d,  excision; 
4th,  by  scraping;  and  5th,  by  crushing. 

As  an  adjunct  to  the  various  instruments  which  these  different 
operations  may  require,  metalHc  catheters  are  also  necessary. 

The  Ligature. — The  catheter  being  introduced  into  the  urethra, 
beyond  the  point  where  the  amputation  is  to  be  made,  a  strong 
ligature  is  apjDhed  at  that  point  and  tightened  sufficiently,  if  j)os- 
sible,  to  strangulate  the  portion  of  the  penis  which  is  to  be 
removed.  After  from  twenty-four  to  forty-eight  hours,  the 
external  layers  of  the  tissues  will  have  become  mortified,  even  to 
a  certain  depth  in  the  penis,  and  a  new  ligature  is  then  appHed, 
and  strongly  tied  like  the  first  one.  The  deeper  layers  of  the 
penis  are  also,  after  a  day  or  two  longer,  so  mortified  that  they 
continue  attached  to  the  tissues  above  the  ligature  only  by  a 
small  jiarticle,  which  can  be  divided  with  the  knife.  The  catheter 
may  then  be  removed  or  it  may  be  allowed  to  remaia  in  place  a 
few  days  longer.  No  special  subsequent  treatment  is  required. 
If,  after  a  few  days,  micturation  seems  to  become  difficult,  the 
urethral  opening  may  be  enlarged  by  the  introduction  of  a  bougie 


572  OPERATIONS    ON    THE    GENITO-UEINAKY    APPARATUS. 

or  a  catlieter,  or  again  enlarged  by  an  incision  with  the  bistoury. 
Instead  of  the  ordinary  string,  an  elastic  ligatm-e  may  be  sub- 
stituted with  the  advantage  of  maintaining  an  uninterrupted  pres- 
sure upon  the  tissues  up  to  the  moment  when  mortification  is 
established  in  the  part  to  be  amputated. 

Cauterization. — No  catheter  is  required  with  this  plan.  Two 
ligatures  are  applied,  one  anterior,  by  which  the  penis  is  kept  out 
of  its  sheath,  and  one  posterior,  acting  as  a  hemostatic,  placed 
above  the  point  where  the  division  is  to  be  made.  The  operator 
then  with  a  flat  and  sharp  cautery,  heated  to  white  heat,  makes  a 
complete  section  of  the  penis. 

But,  says  Zundel,  "  as  the  urethra  is  especially  dehcate  and 
sensitive,  it  is  better,  in  order  to  avoid  its  retraction,  to  separate 
it  from  the  cavernous  body  about  half  an  inch  in  front  of  the  place 
where  the  section  is  made."  A  hollow  bougie  of  india  rubber 
inserted  into  the  urethra  will  also  prevent  its  contraction. 

Professor  Nocard  has  recommended  the  use  of  the  galvano- 
cautery,  to  obtain  an  easier  division  of  the  tissues,  a  more  perfect 
hemostatis  and  to  shorten  the  duration  of  the  operation. 

Excision. — After  introducing  a  metallic  catheter,  a  rapid  sec- 
tion of  the  organ  is  made  by  a  single  stroke  of  the  knife.  Again, 
says  Zundel,  "  when  the  lu-ethra  is  reached,  it  must  be  dissected 
a  little  forward,  toward  the  glans  penis,  and  caused  to  protrude 
about  half  an  inch  beyond  the  point  cauterized." 

Scraping  of  the  perns. — This  method,  which  was  put  in  prac- 
tice in  1829  by  Moiroud  and  Delafond,  consists  in  scraping  the 
penis  with  a  bistoury,  in  such  a  way  that  the  remaining  portion  of 
the  organ  forms  a  cone,  with  its  apex  formed  by  the  urethra.  A 
catheter  may  be  introduced  into  the  canal  previous  to  the  opera- 
tion and  left  in  place  for  awhUe  ;  or  again,  it  may,  if  thought 
proper,  be  entirely  dispensed  mth.  This  mode  precludes  the 
danger  of  hemorrhage. 

Crushing. — By  operating  with  the  ecraseur,  the  amputation  is 
perfected  without  danger  of  hemorrhage.  The  chain  of  the 
instrument  is  applied  at  the  point  of  amputation,  and  by  slow  and 
gradual  action,  cuts  through  the  tissues  until  the  diseased  part 
drops  off.  The  danger  attending  this  method  is  that  the  chain 
may  break  during  the  process,  in  consequence  of  the  resistance  of 
the  cavernous  tissue.  This  accident  has  certainly  been  encoun- 
tered by  many  practitioners,  and  we  have  oui'selves  witnessed  it 


AMPUTATION    OF    THE    PENIS..  573 

in  two  instances.  On  one  occasion  it  was  found  necessary  to  re- 
place the  chain  twice,  and  to  complete  the  amputation  with  the 
knife. 

Eeynal  has  modified  the  crushing-  operation  by  making  the 
action  of  the  ecraseur  slower.  He  has  invented  a  small  instru- 
ment (ecraseur)  which  is  left  in  place  for  two  or  three  days,  being- 
tightened  every  day,  or  several  times  a  day,  until  the  mortification 
is  complete,  and  the  diseased  penis  sloughs  off.  In  this  method, 
a  metallic  catheter  is  placed  in  the  urethra ;  in  the  other  the 
catheter  is  not  required. 

In  reflecting  upon  the  various  modes  of  operation  we  have 
thus  described,  and  noting  especially  the  two  very  important,  and 
indeed,  essential  requirements  referred  to  by  Zundel,  in  respect  to 
the  matters  of  micturition  and  hemorrhage,  we  are  struck  with 
the  fact  that  in  none  of  those  methods  are  these  obvious  require- 
ments comj)lied  with,  or  if  they  are,  it  is  in  a  manner  so  faintly 
implied,  and  so  indefinite  and  unsatisfactory  as  to  be  scarcely 
intelligible,  and  certainly  to  leave  no  distinct  impression  on  the 
mind,  of  the  importance  of  the  points  referred  to. 

In  every  case  the  danger  of  possible  subsequent  interference  with 
micturition  is  threatened,  whether  the  catheter  is  used  during  or 
after  the  operation,  or  even,  we  fear,  if  left  in  the  passage  "  at  least 
two  months,"  as  recommended  by  Peuch  and  Toussaint.  We  can 
remember  cases  of  our  own  which,  with  even  a  longer  retention 
of  the  catheter,  were  followed  by  failure.  We  have  attempted  the 
formation  of  an  artificial  urethral  opening  below  the  ischial  arch, 
and  with  no  better  result. 

We  are  tempted  to  believe  that  the  hemorrhage  is  less  danger- 
ous than  many  think,  and  we  beheve  it  could  be  controlled  by 
ordinary  pressure,  or  by  plugging  the  sheath  afterward,  or  by 
still  other  means  of  hemostasia. 

Taking  all  this  into  consideration,  we  cannot  but  think  strange 
of  it,  that  the  process  used  in  human  surgery,  which  we  find 
merely  mentioned  in  some  European  works,  but  which  we  believe 
has  been  performed  by  Gerlach,  and  which  we  ourselves  adopted 
more  than  fifteen  years  ago,  should  be  practically  ignored  or 
rejected  by  writers  as  well  as  practitioners.  We  have  practiced  it 
during  the  period  mentioned  without  having  encountered  the 
sHghtest  comj)lication  or  troublesome  sequelae. 

We  refer  to  it  as  the  only  safe,  and  as,  therefore,  the  best  mode 


574  OPERATIONS    ON    THE    GENITO-UEINAEY    APPARATUS. 

of  operation  for  the  amputation  of  the  penis.     It  differs  from  any 
that  have  been  previously  recommended,  and  is  as  follows  : 

The  animal  being  prepared  for  the  operation  in  the  ordinary 
way,  the  penis  is  secured  with  a  ligature  at  its  end  and  drawn 
out  of  the  sheath,  and  another  ligature  tightly  appUed  on  the 
upper  part  of  the  organ.  An  incision  of  the  skin  covering  the 
penis  is  made  entirely  around  the  organ  and  down  to  the  cavern- 
ous body,  with  the  precaution  of  drawing  the  skin  slightly  back- 
ward, so  that  when  the  amputation  is  completed,  and  the  skin 
allowed  to  return  to  its  position,  it  will  slightly  overlap  the  stump 
of  the  penis. 

We  divide  the  cavernous  body,  carefully  avoiding  injury  to  the 
urethra,  and  when  this  organ  is  reached  it  is  dissected  from 
its  groove  forward  into  the  cavernous  body  (Figure  4:77a)  for  a 


Fig.  477a.— Amputated  Penis,  with  the  Urethra  Protruding. 

length  extending  between  one  and  one-half  to  two  inches,  when 
the  division  across  the  urethral  canal  completes  the  amj)utation. 
The  removal  of  the  diseased  tissue  being  thus  made,  we  have  before 
us  the  stump  of  the  cavernous  body,  almost  dry,  the  hemori'hage 
being  prevented  by  the  upper  Ugatm-e,  which  moreover,  secures  a 
good  hold  and  good  view  of  the  mutilated  organ.  The  urethra  is 
then  slit  on  its  inferior  border  on  the  median  raphe  and  both  flajDS 
turned  upward  and  brought  in  contact  by  interrupted  sutm-es  with 
the  skin  which  has  been  so  divided  as  to  overlaj)  the  stump 
(Fig.  477/^).  These  sutures  are  made  close  to  each  other,  of  strong 
silk  or  catgut.  The  result  is  that  the  stump  of  the  penis  carries 
at  its  lower  margin  a  sHt  of  from  one  to  one  and  one-half  inches 
in  length,  which,  after  allowing  for  all  shrinkage  of  cicatricial 
tissue,  will  always  be  sufficient  to  permit  thorough  micturition. 


AMPUTATION   OF    THE   PENIS. 


575 


Fig.  4776,— Stump  of  Amputated  Penis,  with  Stitches  uniting  Urethra  and  Skin. 

The  sewing  done  and  the  upper  ligature  removed,  the  penis  re- 
tracts within  the  sheath,  and  the  animal  is  allowed  to  rise. 

"We  have  been  performing  this  operation  for  fifteen  years,  and 
have  never  yet  met  with  the  slightest  complication  or  disappoint- 
ment. 

In  dogs  the  amputation  of  the  penis  is  indicated  for  about  the 
same  diseased  processes  as  in  the  horse.  The  amputation,  however, 
does  not  include  only  the  soft  tissues,  but  also  the  bone  of  the  penis, 
which  is  divided  with  nippers  or  a  saw.  The  division  of  the  cav- 
ernous body  is  done  with  the  ligature  or  the  ecraseur.  Strictures 
of  the  urethra  are  of  common  occurrence  after  this  operation,  and 
can  be  overcome  only  by  the  repeated  introduction  of  the  catheter, 
or  the  enlargement  of  the  urethral  opening  with  the  knife. 


CHAPTER  Xm. 

OPERATIONS   ON  THE  FOOT. 

ANATOMY. 

In  our  domestic  animals  we  call  tlie  foot  tlie  extremity  of  the 
leg,  and  even  only  the  extremity  of  the  digit,  for,  considered  in  a 
zoological  point  of  view,  the  foot  extends  from  the  carpus  or  tar- 
sus to  the  last  phalanx,  inclusive. 

The  foot  of  the  horse  forms  an  extremely  imj)ortant  study  on 
account  of  the  numerous  diseases  to  which  that  member  is  sub- 
ject, and  also  of  the  value  of  the  motor  powers  required  from  the 
horse  ;  the  old  horsemen  expressed  this  importance  by  the  aphor- 
ism, "no  foot,  no  horse."  This  truth  finds  daily  its  sad  appHcations 
in  the  premature  ruin  of  large  numbers  of  horses  rendered  useless 
because  of  the  defects  in  their  feet.  All  the  quahties  of  a  horse 
are,  indeed,  considerably  diminished  and  can  even  be  entu-ely 
destroyed,  by  the  bad  conformation  or  accidental  alterations  of 
these  essential  organs.  The  study  of  the  foot  of  the  horse  has 
been  the  object  of  many  voluminous  works,  such  as  those  of  Gir- 
ard,  Bouley,  Bracy,  Clark,  Anker,  Leisering  &  Hartman,  Lafosse, 
Gourdon,  Reynal,  Defays,  and  many  others,  to  which  we  refer  for 
the  more  complete  description  of  the  organization  of  the  foot. 

The  organ  is  composed  of  two  orders  of  parts,  some  internal, 
organized  and  sensitive ;  the  other  external,  formed  of  a  horny, 
organic  substance,  the  hoof,  but  entirely  void  of  the  property  of 
vital  sensitiveness.  The  internal  parts  are  bones,  three  in  number, 
the  second  and  third  phalanges,  and  the  small  sesamoid,  which 
form  by  their  reunion  the  articulation  of  the  foot ;  special  liga- 
ments, which  maintain  the  connections  of  these  bones  ;  tendons, 
which  fiU  the  trij)le  office  of  agents  of  transmission  of  motion, 
articvilar  ligaments  and  organs  of  support  of  the  weight  of  the 
body ;  a  fibro-cartilaginous  apparatus,  superadded  to  the  third 
phalanx,  and  which  completes,  so  to  sjjeak,  jDOsteriorly,  and 
increases  the  surface  by  which  it  rests  on  the  hoof  and  transmits 


ANATOMY    OF    THE    FOOT. 


577 


Fig.  478.  -Longitudinal  Section  of  the  Digital  Region 


teched  to  the  oa  coroniB.    I.  -Insertion  of  plantar 
K.— bpongy  structure  of  08  suffraginis.    L,     ~ 


H.— Porforatus  tendon  at- 
aponeurosis  to  the  semi-lunar  crest. 


to  the  ground  the  pressure  which  it  receives.  These  are  the  lat- 
eral cartUages  audthe  plantar  cushion;  arteries,  veins,  lymphatics 
and  nerves,  remarkable  for  their  number,  development  and  dispo- 
sition; and  at  last,  a  ligamentous,  sub-horny  membrane,  or  kera- 


578 


OPERATIONS   ON    THE   FOOT. 


Fig.  479.— Plantar  Nerves  in  Digital  Eegion. 

P.— Plantar  nerve.  A.— Origin  of  the  digital  nerves.  B  B.— Cartilaginous  branch. 
C  C— Cutaneous  branch.  D  —Digital  artery.  G.— Transverse  branches  back  of  the  fet- 
lock joint.  I.— Nerve  of  the  plantar  cushion.  L.— Lateral  band  of  the  plantar  cushion, 
v.— Digital  vein. 

togenous  apparatus,  forming  a  continuation  of  the  skin,  which 
surrounds  the  parts  of  the  foot  like  a  stocking,  and  upon  which 
the  foot  rests,  as  a  shoe  on  the  human  foot.  In  this  apparatus  are 
found:  1st,  the  coronary  band,  which  forms  a  rounded  projection 
at  the  separation  of  the  skin  and  hoof,  and  which  serves  as  a 
matrix  to  the  perioj)le  and  the  wall ;  at  its  surface  are  seen  numer- 
ous villosities  or  papillse  ;  2d,  the  podophyllous  or  laminated  tissue 
which  is  spread  upon  the  anterior  face  of  the  third  phalanx,  and 
is  remarkable  by  the  sheet  of  j)arallel  laminse  which  it  presents  at 
its  surface,  separated  by  deep  furrows  in  which  are  received  the 
analogous  laminpe  of  the  internal  face  of  the  wall  (Figure  481) ; 


ANATOMY    OF    THE    FOOT. 


579 


Fig.  480.— Arteries  of  the  Digital  Region. 
AAA.— Digital  artery.  B.— Transversal  branch  in  front  of  fetlock  ioint  C— Per- 
pendicular artery  of  Percival.  D.— Its  ascending  branch.  E.— The  descending  branch. 
F.— Branch  to  form  the  superficial  coronary  circle.  G.— Posterior  transverse  branches. 
K.— Artery  of  the  plantar  cushion.  P.— Circumflex  artery.  CO.— Ascending  terminal 
branches  of  the  digital  artery. 

3d,  the  velvety  tissue  or  villous  tunic  which  covers  the  plantar 
cushion  at  the  interior  face  of  the  foot,  and  is  the  secreting  organ 
of  the  sole  and  frog,  its  surface  covered  with  villosities  similar  to 
those  of  the  coronary  band,  and  like  them,  of  various  sizes,  are 
lodged  in  the  porosities  of  the  internal  face  of  the  sole  and  frog. 
The  external  parts  of  the  foot  are  four  in  number  :  the  wall. 


580 


OPERATIONS    ON    THE    FOOT. 
A  A 


I 


Fig.  481.— Portion  of  the  KeratogenouB  Apparatus. 
A.— The  skin.    B  B.— Coronary  baud.    R.— Its  villosities.    P.— Podophyllous  tissue. 


6/  ? 

Fig.  482.— Section  of  the  Hoof. 
1.— Periople.    2.— Cutigeral  cavity.   3.— Keraphillous  tissue.    4.— Wall.    5.— Contin- 
uation of  the  periople  with  the  frog.    6.— The  sole.     7.— Union  of  the  sole  and  wall. 
8.— Frog  stay. 

the  sole,  tlie  frog  and  the  periople  (Fig.  482).  These  form, 
together,  a  homy  box,  the  nail,  or  hoof,  which  is  adapted  exactly 
by  its  internal  cavity  to  the  external  contour  of  the  sub-horny 
membrane,  contracting  with  it  an  intimate  union  by  a  reciprocal 
reception,  and  thus  completing  the  structure  of  the  foot,  fui*nish- 
ing  to  the  sensitive  parts  an  apparatus,  thick,  hard,  resisting  and  at 
the  same  time  elastic,  which  makes  one  with  them,  and  protects 
them  against  violence  from  the  substances  with  which  the  foot, 
from  the  nature  of  its  function,  must  necessarily  come  in  contact. 


ANATOMY    OF    THE    FOOT.  581 

The  horny  substance  which  constitutes  the  hoof  has  a  fibrous 
aspect ;  it  is  hollowed  all  over  by  cylindrical  canals,  whose  superior 
extremities,  widened  into  a  funnel  shape,  cover  the  papillse  of  the 
matrix  of  the  hoof,  either  at  the  coronary  band  or  velvety  tissue, 
while  the  inferior  open  in  the  wall  upon  the  plantar  border,  in  the 
sole  and  frog,  at  the  external  or  inferior  face.  These  canals  are 
rectilinear,  except  those  of  the  frog,  which  are  flexuous  ;  their 
diameter  varies  from  0,  02  to  0,  2  or  04"'°-  These  tubes  are  not 
only  hollowed  in  the  horny  substance  ;  they  have  also  proper  walls, 
of  very  great  thickness,  formed  of  numerous  concentrical  layers, 
received  into  each  other.  These  are  lamelljB  of  pavimentous 
epithelium,  which  constitute  the  horny  tissue ;  in  the  walls  of  the 
horny  tubes,  they  are  grouped  flatwise  around  their  inferior  canals, 
and  stratified  from  within  outward,  so  as  to  form  successive  and 
concentrical  layers;  in  the  intertubular  horn,  these  lamellae  are 
not  stratified  in  a  direction  parallel  to  that  of  the  tubes,  but  at 
right  angles  with  it.  Ai'ound  the  tubes,  the  lamellae  have  an 
oblique  intermediate  direction.  A  granular  opaque  substance  fills 
up  the  space  lying  between  the  horuy  tubes  and  the  papillae. 

The  hoof,  which  is  a  part  of  the  epidermis,  develops  similarly, 
that  is,  by  the  constant  formation  of  cells  in  the  layer  which  cor- 
responds to  the  mucous  malpighian  body,  at  the  expense  of  the 
plasma  thrown  off  by  the  numerous  blood-vessels  of  the  keratoge- 
nous  membrane.  The  velvety  tissue  is  the  starting  point  of  the 
elements  of  the  sole  and  frog ;  the  jDerioplic  band  is  the  organ 
secreting  the  periople  ;  and  the  coronary  band  proper,  the  matrix 
of  the  waU.  Upon  these  different  parts,  the  ej^ithelial  cells  multi- 
ply and  flatten  into  lameUte,  in  the  direction  of  the  surface  of  the 
keratogenous  membrane,  as  they  spread  from  it.  The  wall  then 
grows  from  its  superior  to  the  inferior  border,  and  the  other  parts 
of  the  wall  from  their  internal  to  their  external  face.  The  villosi- 
ties  of  the  coronary  band  and  of  the  velvety  tissue  are  the  organs 
around  which  accumulate  the  epithelial  cells ;  their  presence 
defines,  consequently,  the  tubular  structure  of  the  horn. 

The  laminse,  ui  the  physiological  state,  do  not  co-operate  in  a 
sensible  manner  with  the  formation  of  the  wall ;  the  keraphyllous 
laminae  form  themselves  at  the  coronary  band,  at  the  origin  of  the 
podophyllous  ;  they  descend  with  the  wall,  gliding  at  the  surface 
of  the  layer  of  cells  which  separates  them  from  the  laminated 
tissue,  a  movement  of  descent  which  is  facihtated,  however,  by  the 


582  OPEEATIONS    ON    THE    FOOT. 

multiplication  in  the  same  direction  of  the  said  cells.  When  the 
podophyllous  tissue  is  inflamed,  whether  exposed  or  not,  its  latent 
activity  soon  manifests  itself.  It  gives  rise  to  a  great  quantity  of 
hard  horn,  hollowed,  as  seen  by  Gourdon,  with  tubes,  and  oblique 
in  a  du-ection  backward.  These  tubes,  more  irregular  than  those 
of  the  normal  wall,  are  disposed  in  a  parallel  series  ;  they  are  in 
form  round,  villo-papillfe,  which  have  developed  on  the  face  border 
of  the  laminae.  In  these  cases  of  production  of  horn  by  the  action 
of  the  podophyUous  tissue  alone,  ojie  never  sees,  between  the 
sensitive  laminse,  distinctly  formed  horny  laminse  in  the  middle  of 
the  other  cells,  as  it  is  observed  in  the  wall  proceeding  from  the 
coronary  band.  The  horn  which  rises  on  the  surface  of  the 
podophyllous,  immediately  after  the  removal  of  the  piece  of  the 
wall,  is  not  a  permanent  one ;  it  must  be  replaced  by  the  horn 
of  the  coronary  band.  This  change  is  complete,  microscopical 
examination  proving  that  the  wall  which  descends  from  the 
coronary  band,  provided  with  keraphyllous  laminse,  engages  itself 
under  the  temporary  wall,  and  slides  by  the  action  already 
described  over  the  surface  of  the  soft  cells  of  the  laminated  tissue. 
As  soon  as  this  tissue,  modified  by  inflammation,  is  covered  over 
by  the  permanent  wall,  its  papillae  become  atrophied,  and  its  action 
returns  to  the  limited  boundaries  of  physiological  condition. — 
{Chauveau.) 

The  foot  is  an  organ  of  support  and  an  apparatus  of  elasticity; 
it  is  through  it  that  the  whole  animal  machine  maintains  its  rela- 
tions with  the  groimd,  and  that  it  adapts  itself  in  its  various  move- 
ments, so  to  speak,  to  its  roughness.  It  is  this  that,  as  a  last 
spring,  distributes  and  modifies  the  force  of  all  the  movements  of 
the  horny  mass  of  the  body,  whose  columns,  the  legs,  may  be 
considered  as  the  resultant.  Intermediate  with  the  body  and  the 
ground,  the  foot  transmits  all  the  actions  of  weight  reaching  it, 
and  also  between  the  body  and  the  sensorium,  toward  which  all 
sensations  resulting  from  its  contact  with  surrounding  external 
substance  return,  the  foot  then  becoming  at  the  same  time  an  organ 
of  feeling.  To  adapt  it  to  this  triple  formation,  nature  has  given 
to  it  three  properties,  in  appearance  incompatible  with  each  other, 
which  has,  however,  harmonized,  viz.:  first,  a  very  great  external 
hardness,  due  to  its  horny  envelope ;  second,  a  certain  amount  of 
flexibility,  the  combined  result  of  the  physical  properties  of  its 
cortical  envelope  and  of  its  mechanical  disposition  of  its  different 


ANATOMY  OF  THE  FOOT. 


583 


parts,  and  thii'dly,  a  higlily  developed  sensibility  resulting  from 
the  high  organization  of  its  tegumentary  membrane. — Bouley. 

DISEASES   AND    DEFECTUOSITIES    OF    THE   FOOT    IN    SOLIPEDS. 

Of  all  the  domestic  quadrupeds,  the  horse  is  the  most  exposed 
to  diseases  of  the  foot,  which  are  more  or  less  frequent  in  him 
according  to  the  work  he  is  subjected  to,  the  places  he  lives  in, 
and  the  nature  of  the  ground  upon  which  he  travels.  As  rare  as 
are  those  accidents  ia  farm  horses,  so  common  are  they  among 
horses  in  cities,  of  heavy  draught,  and  also  army  horses  ;  in  all,  in 
fact  which  travel  continually  on  hard,  j^aved  and  stony  roads,  and 
especially  in  large  cities,  where  all  those  injuries  can  but  be  the 
result  of  their  constant  work  on  stone  pavements,  always  so  rough 
and  shppery.  If  to  these  conditions  are  added  the  very  numerous 
accidents  resulting  from  bad  shoeing,  so  badly  carried  on,  one  will 
be  less  stu'prised  to  see  the  foot  becoming  deformed  and  altered 
in  different  ways,  deteriorated,  and  preserving  with  difficulty,  and 
for  a  short  time,  its  state  of  integrity,  and  becoming  the  seat  of 
numerous  affections. 

We  shall  distinguish  the  diseases  proper  and  the  vices  of 
conformation  of  the  foot.  The  former  are  generally  sufficiently 
serious  to  merit  special  description.  Among  them  some  are  su- 
perficial, as  the  false  quarters,  uncomplicated  cracks,  or  solution 
of  continuity,  thrushes,  canker;  others  of  deeper  interest,  specially 
those  of  the  keratogenous  apparatus,  such  as  laminitis,  with  its 
complications  and  sequelae,  keraphylocele,  seedy  toe,  and  sep)aration 
of  the  wall,  which  may  extend  as  far  as  entire  sloughing  of  the 
hoof  ;  accidents  then  due  to  the  suppuration  accompanying  several 
diseases  of  the  foot.  Some  maladies  are  specially  the  effects  of 
wounds,  of  contusions  such  as  overreaching,  quittor,  bruised  sole, 
bruised  heels,  corns,  punctured  wounds;  others  are  results  of 
shoeing,  pricked,  tight  shoe,  burned  sole;  others  are  deep  alto- 
gether, such  as  bionions,  navicular  disease,  and,  lastly,  fracture  of 
the  OS  2)edis,  or  of  the  navicidar  bone. 

VICES    OF    CONFORMATION. 

Among  the  vices  of  conformation  some  are  serious,  as  contrac- 
tion of  the  heels,  flat  foot,  pumiced  foot,  club  foot,  crooked  foot, 
rammy  foot,  and,  lastly,  the /c»o«  with  bad  horn. 


584  OPERATIONS    OK    THE    FOOT. 

(a)  Flat  foot  (Germ.  Platfuss). — By  tliis  is  understood  the 
foot  in  wliicli  the  sole,  instead  of  having  the  natural  concavity,  is, 
on  the  contrary,  flat,  and  by  its  whole  surface  about  on  a  level 
with  the  border  of  the  wall  and  the  base  of  the  frog ;  ordinarily 
this  is  accompanied  with  low  heels,  more  or  less  contraction,  and 
a  well-marked  oblique  direction  of  the  wall. 

Flat  foot  is  generally  observed  only  on  front  feet,  and  is  very 
common  in  lymphatic  animals  or  of  low  breed,  raised  in  low  and 
damp  soils  ;  it  may  be  congenital.  Large  feet,  badly  shod  or  used 
up  by  very  heavy  work,  are  predisposed  to  it.  It  is  claimed 
that  the  weakening  of  the  sole  by  too  repeated  and  deep  paring 
of  the  sole  will  ultimately  bring  it  on ;  it  is  said  that  abuse  of 
poultices  may  produce  it ;  it  follows  excess  of  the  hollowing  of  the 
shoe  by  the  upper  surface,  which,  pushing  the  wall  outward, 
obliges  the  sole  to  drop  lower  than  its  normal  level. 

The  horse  with  flat  foot  rests  on  all  parts  of  the  sole  at  once ; 
there  is  no  elasticity  of  the  arch  of  the  sole,  and  percussions  take 
place  on  it  entirely.  The  actions  of  the  animal  are  heavy,  espe- 
cially as  it  is  commonly  seen  when  the  feet  are  large.  When  the 
foot  is  somewhat  tender,  the  animal  lames  easily,  especially  if  the 
shoeing  is  bad,  or  if  the  animal  rests  on  the  sole  or  is  obHged  to 
trot  on  rough  or  stony  roads,  which  render  the  percussion  very 
painful.  There  arises  some  irritation,  which  keeps  on  increasing, 
and  produces  several  accidents,  such  as  bruised  sole,  corns, 
pumiced  feet. 

The  horse  which  has  flat  feet  often  has  weak  walls,  and  as  the 
nails  of  the  shoe  become  loose,  this  is  often  cast. 

By  shoeing  one  may  remedy  this  bad  condition  of  the  foot. 
For  this,  the  foot  must  be  pared  flatways,  the  sole  spared,  the  wall 
relieved  only  of  what  is  broken  oif ;  the  frog  must  be  left  alone, 
the  heels  also ;  a  shoe  somewhat  wide  in  the  web,  protecting, 
therefore,  the  sole  more  than  an  ordinary  shoe  does.  It  will  be 
adjusted  so  as  to  rest  on  the  border  of  the  wall  only,  and  not  on 
the  sole  ;  still,  care  will  be  taken  not  to  hollow  it  too  much  or  to 
excess.  Sometimes  a  thick  shoe  only  is  necessary,  without  in- 
creased width.  Soles  of  gutta-percha  or  felt  are  also  used,  as 
we  will  see  when  speaking  of  the  pumiced  foot. 

(b)  Pumiced  foot  (Germ.  Vollfuss). — Thus  is  called  the  foot 
whose  sole  projects  beyond  the  level  of  the  wall,  and  presents  a 
convex  surface,  extending  beyond  the  plantar  bordei-,  upon  which 


ANATOMY    OF    THE    FOOT.  585 

the  horse  rests.  It  is  the  exaggeration  of  the  flat  foot.  In  the 
pumiced  foot  the  wall  has  a  great  obliquity,  sometimes  even 
assuming  a  nearly  horizontal  direction. 

The  horse  is  never  born  with  such  feet;  this  is  a  malformation, 
accidental,  or  resulting  from  various  causes.  One  of  the  most 
common  is  lack  of  care  of  the  foot,  of  necessary  caution,  for 
instance,  in  paring,  or  shoeing  in  such  a  way  as  to  bring  the  rest 
of  the  foot  on  the  cii'cumference  of  the  under  part  in  such  a  way 
that  the  sole  does  not  touch  the  ground,  and  ceases  to  be  pressed 
by  it.  Too  much  concavity  of  the  shoe  may  bring  on  this  result, 
by  resting  only  on  a  too  narrow  part  of  the  inferior  border  of  the 
foot ;  and  by  opposition,  not  enough  concavity  will  compress  the 
tissues,  irritate  them,  and  produce  the  same  alteration.  Feet 
become  pumiced  by  laminitis,  but  this  is  compHcated  with  seedy 
toe.  Nevei',  then,  is  the  foot  pumiced  in  its  whole  extent ;  its 
deformity  stops  always  at  the  limit  of  the  inferior  border  of  the 
bars ;  beyond  them,  behind,  on  each  side  are  seen  the  excavations 
of  the  lateral  lacunse  of  the  frog,  so  much  deeper  that  heels  are 
higher.  The  hoof  does  not  preserve  its  circular  shape.  It  atro- 
phies on  the  side,  and  presents  at  the  toe  an  excess  of  thickness 
in  the  wall;  the  heels  assume  a  greater  development. 

This  deformity  is  very  serious,  and  disables  the  horse  easily ; 
rest  takes  place  only  upon  the  sole  and  frog  ;  after  laminitis,  upon 
the  sole  and  heels ;  it  is  always  very  painful.  Work  upon  hard 
ground  and  pavement  is  next  to  impossible.  After  laminitis,  one 
sees,  during  walking,  that  the  foot  rests  upon  the  heels,  and  then 
by  a  motion  from  backward  to  forward.  An  animal  with  pum- 
iced feet  has  a  tendency  to  f,orge  and  interfere;  the  slightest 
bruise  of  the  sole  gives  rise  to  serious  compHcations.  One  often 
observes  wounds,  suppurations,  etc. 

The  indications  are  analogous  to  those  of  the  flat  foot;  the 
sole  ought  to  be  si>ared  as  well  as  the  frog,  the  walls  only  ought 
to  be  slightly  trimmed ;  the  shoe  must  be  made  so  as  to  carry 
the  rest  upon  the  border  of  the  wall  and  protect  the  sole.  When 
the  foot  is  not  pumiced  to  excess,  one  must  use  a  broad  web  shoe, 
sufficiently  concave  to  allow  the  sole  to  rest  in  it ;  but  it  must 
not  be  too  excessive,  as  then  the  base  of  the  rest  would  not  be 
very  firm.  A  sheet  of  gutta-percha,  or  felt,  with  tar  and  oakum, 
may  be  placed  between  the  shoe  and  the  foot. 

(c)   Club  foot  (Germ.  Bockhuf). — This  is  the  foot  in  which  the 


586  OPERATIONS    ON    THE    FOOT. 

"wall  is  straightened  more  or  less  perj^endicularly,  or  even  obliquely 
backward,  so  that  the  superior  border  of  the  wall  is  more  forward 
than  the  inferior.  The  superior  levers  participate  always  in  this 
vicious  direction,  which  constantly  brings  back  the  rest  of  the 
foot  toward  the  anterior  jDart  of  the  wall,  and,  according  to  its 
degree,  makes  the  animal  walk  more  or  less  on  the  toe,  even  some- 
time obliging  him  to  rest  on  the  anterior  face  of  the  hoof ;  the 
heels  are  raised  from  the  ground,  and  the  fetlock,  instead  of  being 
open  forward,  seems  to  be  turned  backward.  This  deformity, 
which  exists  especially  in  the  hind  legs,  is  very  common,  and  is 
even  natural  in  mules,  and  supposes,  with  its  presence,  high  heels, 
which  throw  the  rest  on  the  toe,  which  is  always  very  thick.  It 
may  also  exist  with  low  heels,  especially  when  due  to  ovei'work  or 
other  accidental  cause.  Horses  which,  like  mules,  are  club-footed 
only  by  a  peculiar  condition  of  the  parts,  walk  with  firmness,  and 
even  pull  better  and  work  better  in  hilly  countries.  If  they  are 
unfit  for  the  saddle,  it  is  because  their  reactions  are  hard,  and  that 
they  tire  the  rider.  It  is  not  so  with  those  which  are  club-footed 
from  hard  work  ;  they  continually  stumble,  are  subject  to  knuck- 
ling, to  interfering,  or  even  to  falling ;  and  for  these  reasons  do 
they  always  require  a  mode  of  shoeing  which  would  give  them  the 
missing  solidity,  and  render  their  walk  more  steady.  This  cir- 
cumstance indicates  the  necessity  of  sparing  the  toe,  and  throwing 
the  weight  back  on  the  heels,  which,  however,  must  not  be  pared 
off  too  much.  The  best  shoe  for  such  feet  must  be  short,  thin  at 
the  heels,  with  a  thick  toe,  slightly  raised  upward,  and  prolonged 
beyond  the  level  of  the  border  of  the  wall ;  small  heels  to  the  shoe 
are  often  advantageous,  as  giving  an  opportunity  for  rest  and 
relief.  The  shoe  with  truncated  branches  of  Lafosse  (slipper), 
which  is  a  short  shoe,  not  extending  beyond  the  quarters,  and 
leaving  the  heels  free,  is  sometimes  used.  This  shoe  is  very  thick 
at  the  toe,  and  very  thin  at  the  heels.  It  is  unnecessary  to  say 
that  club  foot  is  often  cured  by  tenotomy,  or  by  treatment  of  the 
tendinous  retraction. 

id)  Crooked  foot. — We  call  by  this  name  the  foot  whose  sides 
are  not  of  the  same  height ;  it  may  be  crooked  outward  or  inward. 

This  deformity  may  result  from  a  vice  of  du^ection  of  the  x-egions 
above  ;  ordinarily,  however,  only  from  a  deviation  of  the  phalan- 
geal one.  Sometimes  it  is  due  to  bad  shoeing,  to  bad  paring  of 
the  feet ;  sometimes  it  f oUows  imequal  wearing  of  the  foot,  it  being 


ANATOMY    OF    THE    FOOT.  587 

without  shoe.  Colts  which  have  never  been  shod,  and  are  walking- 
for  a  long  time  on  hard  and  rough  ground,  often  present  this  con- 
dition. 

The  horse  with  crooked  feet  inward,  specially  if  the  deviation 
is  much  marked  at  the  toe,  is  exposed  to  cut  himself  with  the 
internal  heel  of  the  shoe — to  bruise  himself ;  the  horse  with  crooked 
feet  outward  cuts  himself  with  the  inner  toe.  Besides  these, 
lameness,  from  lacerations  of  articular  ligaments,  may  often  follow. 

This  is  relieved,  especially  in  young  animals,  by  lowering  the 
side  of  the  wall  which  is  the  highest,  and  sparing  the  other ;  the 
proper  shoe  for  this  condition  must  be  thicker  in  the  branch  cor- 
responding to  the  lower  side  of  the  foot.  The  shoe  ought  to  be 
changed  quite  often,  in  proportion  to  the  existing  difference  in 
the  height.  If  the  foot  is  very  crooked,  it  is  difficult  to  straighten 
it  by  having  a  greater  thickness  of  the  shoe ;  it  would  make  this 
too  heavy.  Sometimes  it  is  better  to  use  nails  with  large-sized 
heads  on  the  lower  side  of  the  hoof  ;  and  in  these  cases  one  might 
put  on  corks  at  the  heels,  external  or  internal,  as  required. 

(e)  Mammy  foot. — This  is  a  defectuosity  of  the  foot,  always 
accidental,  in  which  the  surface  of  the  wall  offers  more  or  less 
numerous  circles,  above  each  other  and  running  from  one  quarter 
or  heel  to  that  of  the  other  side.  These  roughnesses,  arrranged 
in  rows,  rise  always  from  the  coronary  band,  and  form  as  many 
elevations  gradually  descending  and  disappearing  toward  the  in- 
ferior border  of  the  wall.  They  are  so  much  more  serious  that 
they  are  deep,  and  sometimes  are  accompanied  with  lameness, 
especially  when  in  great  number,  close  to  each  other,  and  when 
the  foot  is  narrow  and  long.  These  circles  are  sometimes  seque- 
lae of  laminitis,  and  accompany  seedy  toe ;  the  rings  are  then  in 
the  middle  of  the  toe,  which  is  more  or  less  roughened,  like  an  oyster 
shell,  and  they  disappear  only  when  the  primitive  alteration  is 
removed.  When  they  are  small,  not  numerous,  and  grow  down 
without  being  replaced  by  new  ones,  this  favorable  disposition  of 
the  wall  must  by  stimulated  by  all  the  means  which  may  stimulate 
and  keep  up  the  suppleness,  by  Hght  bhsters  over  the  coronet.  A 
light  shoeing,  often  changed,  is  the  best  in  those  cases.  Circles 
which  reappear  continually  are  due  to  an  intimate  and  continued 
alteration,  and  are  in  company  with  other  defectuosities,  such  as 
contraction,  pumiced  foot,  etc. 

{/)  Foot  with  had  hoof. — A  hoof  may  be  too  soft  or  too  dry. 


588  OPERATIONS    ON    THE    FOOT. 

When  too  soft,  too  greasy,  it  contains  too  much  dampness  and  is 
lacking  resistance.  Horses  which  have  this  weak  hoof,  as  said 
Laf osse,  have  the  foot  tender  and  unfit  for  long  walks  on  hard  and 
stony  ground  ;  they  are,  besides,  much  exposed  to  lose  their  shoes, 
because  the  hoof  breaks  up  at  the  nail-holes.  This  fault  is  quite 
common  in  large  feet,  frequently  seen  in  Northern  lymphatic  ani- 
mals, especially  in  those  which  come  from  marshy  districts ;  if,  then, 
those  horses  are  submitted  to  stabulation,  their  hoof  becomes  dry 
to  excess,  which  gives  rise  to  narrow  and  contracted  feet.  The 
lower  part  of  the  foot  must  be  pared  with  care,  as  it  has  but  httle 
thickness  ;  the  application  of  the  warm  shoe  while  fitting  must  be 
as  short  as  possible.  An  ordinary  thin  and  light  shoe  must  be 
used  ;  the  naUs  will  be  as  light  and  thin  as  possible,  and  ham- 
mered in  carefully. 

Too  dry  hoof  is  liable  to  break,  because  it  has  lost  its  physio- 
logical suppleness  ;  this  brittleness  is  often  met  in  animals  whose 
feet  have  been  much  in  water  and  afterward  are  placed  on  dry 
ground ;  it  seems  as  if  the  water  had  dissolved  the  adhesion  of  the 
horny  cells.  The  same  condition  follows  the  excessive  use  of 
poultices  and  also  of  strong  grease  in  shape  of  ointments.  It  is 
wise  to  grease,  but  previously  the  old  crust  must  be  removed. 
Hoof  ointments  of  wax,  turpentine  or  tar  are  better.  The  foot  is 
called  dc'rohe  (broken)  when  by  the  use  of  a  thick  nail  it  is  more 
or  less  broken  at  the  edges  of  the  wall.  These  feet  lose  the  shoe 
easily ;  animals  then  go  on  bare  feet,  and  then  it  becomes  very 
difiicult  to  pvit  other  shoes  on.  It  is  necessary  in  these  cases  to 
punch  nail  holes  on  the  shoe  corresponding  with  parts  where  the 
hoof  is  sound.  In  paring,  all  the  pieces  of  broken  horn  are 
removed,  or  at  least  as  much  as  can  safely  be  done.  Nails  are 
secured  as  high  as  possible  ;  shoes  must  be  changed  as  often  as 
possible,  and  the  hoof  is  to  be  kept  supple  by  unctuous  api^lica- 
tions.  When  the  breaks  of  the  horn  are  too  large,  softened  gutta- 
percha, or  a  mixture  of  gutta-percha  three  parts,  with  one  of  gum 
ammoniac,  melted  together,  can  be  used  to  fill  the  anfractuosities, 
all  grease  having  been  first  removed  by  a  wash  with  ether  ;  the 
putty  hardens,  and  the  shoe  can  be  tacked  on  solidly.  Nails  can 
even  be  punched  through  the  gutta-percha. 


ANATOMY    OF    THE    FOOT. 


589 


Instruments. 

The  sm-gery  of  the  foot  requires  special  instruments  for  the 
operations  which  influence  action  upon  the  hoof,  as  also  for  those 
which  are  to  be  performed  upon  the  tissues  of  the  foot  proper. 

Besides  those  which  are  commonly  required  in  ordinary  sur- 
gery, such  as  curved  scissors,  probes,  bistouries  and  forceps, 
others  are  needed  of  special  forms  and  for  special  purposes; 
among  those  most  commonly  used  are  the  different  sage  knives 
and  di-awing  knives. 

Sage  knives  are  lanceolated  blades  secured  to  handles,  and 
are  either  double  or  right  or  left.  The  blade,  which  is  curved 
upon  its  long  axis,  may  be  sharp  on  both  edges,  as  in  the  double, 


Fig.  485. 


Pig.  484. 
SAGE  KNIVES. 


(Fig.  483)  or  on  only  one  or  other  edge,  when  it  is  known  as  a 
right  (Fig.  484)  or  left  (Fig.  485)  sage  knife,  being  thus  adapted 
to  use  by  either  the  right  or  the  left  hand. 

Drawing  knives,  which  are  made  somewhat  like  those  used  by 
blacksmiths  in  the  ordinary  method  of  paring  the  foot,  yet  differ 
from  those  in  being  straighter  in  their  attachment  to  the  handle, 
and  also  on  being  curved  on  their  long  axis,  being  also  sharp  on 
both  edges.     The  groove  of  the  instrument  is  made  to  vary  in 


590 


OPERATIONS    ON    THE    FOOT. 


wicltli,  and  thus  can  be  used  as  the  different  steps  of  the  operation 
may  require  (Fig.  486).  Sometimes  the  drawing-  knife  resembles 
more  that  of  the  blacksmith,  as  being  sharp  on  one  edge  only  (Fig. 
487),  and  in  this  case  the  groove  of  the  blade  is  generally  much 
narrower  than  in  the  others.  Some  special  operations  require 
peculiar  forms  of  drawing  knives  ;  for  instance,  those  which  are 


Fig.  487.  Figs. 

DRAWING  KNIVES. 

made  with  a  blade  perfectly  straight  and  narrow,  very  slightly 
sharp  on  the  edges,  but  having  a  very  narrow  groove  at  the  ex- 
tremity (Fig.  488).  These  are  used  principally  in  the  scraping  of 
diseased  bone-structure,  in  deep  punctured  wounds  of  the  foot, 
and  in  cartilaginous  quittor,  when  small  sections  of  cartilage  are 
to  be  removed  from  the  lateral  border  of  the  os  pedis,  which  could 
not  othewise  be  accomplished. 

Other  instruments  are  also  required,  the  description  of  which 
will  be  given  as  we  refer  to  the  different  diseases  where  they  find 
their  applications. 

General  Operations. 

Bemoval  of  the  sole  (Germ.  Absohlen). — This  is  an  operation 
by  which  the  sole  of  the  foot  is  removed  by  severing  it  from  the 
living  tissues  underneath.  In  times  gone  by  this  operation  was 
extensively  performed,  being  considered  indispensable  as  soon  as 
the  slightest  lesion  under  the  sole  existed.     It  was  alleged  that 


ANATOMY    OF    THE    FOOT.  591 

tmless  this  was  done  the  suppui'ation  would  be  likely  to  spread 
uuderneath  tlie  horn.  In  our  days  it  is  rarely  performed,  as  it  is 
considered  that  it  presents  but  little  advantage,  so  far,  at  least,  as 
it  involves  the  removal  of  the  entire  organ.  Sometimes,  however, 
portions  of  it  have  to  be  taken  off,  as  in  some  special  diseased  con- 
dition of  the  foot,  such  as  in  punctured  woimd,  pricking  by  the 
blacksmith,  burnt  sole,  etc.,  the  modus  operandi  of  which  will  be 
considered  when  treating  of  these  diseases. 

Removal  of  portion  of  the  xoall. — A  few  morbid  conditions  of 
Bome  parts  of  the  foot  requii-e  in  their  treatment  the  removal  of  a 
portion  of  the  wall,  in  order  that  the  escape  of  pus,  the  removal 
of  diseased  tissue,  or  the  sloughing  of  necrossed  cartiliginous  or 
bony  structure,  as  in  complicated  cases  of  suppurative  corns,  of 
quarter-crack  or  in  cartilaginous  quittor.  A  similar  operation  is 
sometimes  required  in  cases  of  toe-crack,  complicated  with  disease 
of  the  OS  pedis. 

These  will  be  further  considered  when  ti^eatiag  of  these  special 
subjects. 

Dressings. 

As  nearly  every  operation  of  the  foot  requu'es  a  mode  of  dress- 
ing peculiar  to  the  manipulations  which  have  been  necessary,  we 
shall,  when  speaking  of  the  different  diseases,  where  parts  of  the 
walls  have  been  removed,  iaclude  also  a  description  of  the  pecidiar 
dressing  they  require. 

There  is  one,  however,  which  is  thought  much  of  in  veterinary 
surgery,  and  of  which  we  will  ha*"e  to  say  more  when  speaking  of 
punctm-ed  wounds  of  the  foot.  This  is  the  dressing  with  plates, 
which  serve  to  retain  the  plantar  surface,  the  balls  and  pads  of 
oakum,  which  are  placed  to  protect  the  wound.  The  aj^plication 
of  these  plates  is  far  suj^erior  to  the  leather  sole,  because  of  its 
easy  removal  when  the  parts  are  being  examiaed,  and  of  their  easy 
replacement ;  thus  allowing  the  sui-geon  to  change  the  dressing 
whenever  he  sees  fit,  without  being  obHged  to  remove  the  shoe. 

DISEASES. 

Canker  of  the  Foot. 
(Germ.,  Strahlkrebs,  Hufkrebs). — Under   this    somewhat  un- 
scientific,* though  accepted  name,  is  designated  a  peculiar  disease 

*  Cra/paud  of  the  French. 


592 


OPERATIONS    ON    THE    FOOT. 


of  the  feet  of  solipeds,  seated  in  the  secreting  tissues  of  the  horny 
box,  always  beginning  at  the  frog,  and  characterized  by  alteration 
of  the  homy  secretion.  Names  of  a  more  scientific  meaning  have 
frequently  been  proposed,  such  as  gnawing  ulcer  (Bourgelat), 
schirrus  or  cancerous  carcinoma  of  the  frog,  carcinoma  of  the 
reticular  tissue  of  the  foot  (Vatel),  darter  of  t?ie  plantar  cushion, 
chronic  podoj)arencJiyder7nitis  (Mercier),  and  epithelioma  of  the 
frog  (Fuchs).  None  of  these  has  ever  been  accepted,  and  the  old 
hipj)iatric  name  has  been  retained. 

History. — It  is  conceded  that  the  old  veterinaiians  were  ac- 
quainted with  canker,  and  Vegetius  evidently  speaks  of  it,  but  not 
until  the  time  of  Solleysel  do  we  find  a  descriiDtion  somewhat 
comj)lete  of  the  disease  and  its  treatment ;  Garsault,  La  Gueri- 
niere,  Weyrother  and  others  spoke  of  it,  and  have  expressed 
various  opinions  as  to  its  etiology,  and  especially  as  to  its  treat- 
ment. So  little  progress  was  discernible  in  the  writings  of  Bour- 
gelat, Chabert,  Huzard  and  Gii'ard,  on  that  very  question,  and  so 
many  false  ideas  were  admitted,  that  Chabert  in  despair  has  called 
canker  the  opprobrium  of  veterinary  medicine. 

It  is  but  recently  that  serious  research  as  to  the  natm'e  of 
the  disease  have  thrown  some  hght  on  the  question,  and  estab- 
lished the  important  fact  that  its  seat  is  not  in  the  disorganized 
horn,  but  in  the  secreting  organs,  and  that  there  is  an  alteration 
in  the  products  of  this  secretion  ;  that  it  is  consequently  to  these 
that  remedies  must  be  appHed. 

We  might  refer  to  the  writings  of  Jeannie,  Crepin,  Hurtrel 
d'Ai-boval,  Prevost,  Mercier,  Plasse,  Percivall,  Dietrichs,  Eichbaum, 
Wells,  H.  Bouley,  KejTial,  Haubner,  Fuchs,  Eey,  Megnin,  etc., 
each  of  whom  has  furnished  his  contingent,  while  still  the  inti- 
mate nature  of  the  disease  remains  but  imperfectly  known,  and 
there  is  but  little  certainty  either  in  the  treatment  or  its  resiilts. 

Let  us  observe,  however,  that  in  our  day  canker  has  become 
comparatively  a  rare  disease,  especially  in  cities,  which,  doubtless, 
is  because  of  the  cleanliness  of  the  streets.  In  the  begimiing  of 
this  century,  canker  and  grease — closely  related  diseases — were 
frequent  in  Paris;  then  horses  were  obHged  to  travel  through 
deep  gutters  of  mud,  while  to-day  these  affections  are  excejitional 
occurrences  (H.  Bouley).  The  same  thing  has  been  observed  by 
Percival  in  England.  When  hygienic  precautions  were  not  as 
weU  understood  as   they  are   to-day,  in  establishments   employ- 


DISEASES.  593 

mg  large  numbers  of  horses,  when  the  stables  of  mail  and  stage 
coaches,  and  even  those  of  military  garrisons,  were  small,  ill-venti- 
lated and  dirty,  among  horses  standing  in  filth  and  soiled  manure, 
these  afiections  were  relatively  common ;  with  hygienic  improve- 
ments, they  have  almost  disapj)eared.  In  the  army,  canker  was 
the  cause  of  considerable  annual  loss,  almost  as  serious  as  those 
from  glanders ;  to-day  it  is  rare  and  almost  unknown. 

Improvements  in  the  different  breeds  of  horses,  either  by  bet- 
ter choice  of  reproducers,  or  by  changes  in  the  mode  of  feeding, 
resulting  from  the  progress  of  agricultural  processes,  the  suppres- 
sion of  common  pastures,  etc.,  have  contributed  to  render  the 
disease  less  common. 

Synqitoms. — It  is  seldom  that  the  symptoms  of  canker  can  be 
observed  from  the  start ;  slow  in  its  progress,  and  not  surexciting 
the  sensibHity  of  the  parts,  the  disease  may  progress  without 
manifesting  any  ill  effects,  and  consequently  escape  notice  by  the 
owner  or  groom,  nothing  appearing  to  call  his  attention  to  the 
affected  foot.  Thus,  in  a  majority  of  cases  canker  is  only  dis- 
covered after  it  has  been  in  existence  for  a  considerable  period, 
and  when  serious  alterations  have  already  taken  place.  It  is 
often  at  the  shoeing  shop,  when  the  shoes  are  changed,  that  in 
the  laminse  is  observed  a  moisture  more  or  less  abundant,  giving 
rise  to  softening  and  raising  of  the  hoof.  The  disease  sometimes 
attacks  only  one  foot,  often  several  feet  at  a  time ;  at  times  when 
one  foot  is  cured,  another  becomes  affected,  and  the  disease  thus 
appears  traveling  alternately  from  one  foot  to  another. 

Usually  the  disease  begins  with  the  inflamation  of  the  kerato- 
genous  membrane  which  covers,  the  median  lacunae  of  the  plantar 
cushion ;  the  hoof  covering  this  is  softened,  raised  by  a  serOus 
moisture,  and  once  loose,  is  not  renewed,  the  tissue  producing  it 
having  lost  its  function  of  secreting  the  horny  substance,  and  now 
secreting  a  serous  element,  which  becomes  the  caseous  matter  of 
which  we  shall  speak  hereafter. 

Sometimes  the  disease  begins  by  moisture  in  the  hollow  of  the 
coronet,  by  a  kind  of  grease,  a  disease  which  we  shall  see  to  be  of 
the  same  nature  as  canker.  The  is  an  oedematous  swelling,  warm, 
somewhat  painfvil,  of  the  phalangeal  region,  first  serous,  then  be- 
coming opalescent,  which  seems  to  filtrate  through  the  softened, 
but  not  yet  raised,  epidermis.  This  inflammation,  spreading  little 
by  little  toward  the  hoof,  extends  to  the  plantar  keratogenous. 


594  OPERATIONS    ON    THE    FOOT. 

membrane,  and  gives  rise  to  an  exhalation  of  the  same  nature  as 
that  of  the  skin  which  produces  the  separation  of  the  hoof,  and 
the  first  marks  of  canker. 

Sometimes  one  may  observe  at  once,  a  fungoid  growth  of  ficus, 
formed  by  an  hypertrophy  of  the  tissues  underneath  ;  this  growth 
is  more  or  less  moist  and  offensive,  bleeding  easily,  having  the 
aspect  of  cauliflowers,  and  protruding  through  a  break  of  the 
softened  hoof,  and  forming  a  thready  detritus  to  be  subsequently 
studied.  Commonly,  the  hoof  is  more  or  less  loose,  and  under  it 
is  a  caseous  matter,  greas}^,  ordinarily  of  a  foetid  odor,  easily  re- 
moved by  scraping,  being  non-adherent  to  the  tissue  which 
secretes  it.  If  the  parts  are  well  cleaned  from  this,  the  velvety 
tissue  of  the  pyramidal  body  of  the  frog,  appears  to  be  covered 
with  a  smooth  membrane  of  a  slight  whitish  color  ;  the  external 
layer  then  appears  formed  by  a  pellucid  epidermic  covering,  show- 
ing through  its  transparency  the  purplish  color  of  the  capillaries 
underneath.  The  velvety  tissue  is  diseased,  but  still  retains  its 
functions,  which,  on  the  contrary,  are  increased  but  perverted, 
and  instead  of  secreting  a  horny  substance  which  adheres  to  the 
surface  of  tbe  keratogenous  membrane,  produces  the  caseous  mat- 
ter already  referred  to.  The  break  in  the  hoof  frequently  seems 
small  in  size.  Nevertheless,  the  alteration  of  the  keratogenous 
tissues,  viz :  the  substitution  for  its  normal,  of  a  pathological  se- 
cretion, whose  product  is  this  loose  caseous  matter,  is  far  ad- 
vanced. There  is  then  an  extensive,  though  a  concealed  separa- 
tion of  the  hoof.  One  then  must  not  allow  himself  to  be  deceived 
into  supposing  it  to  be  a  limited  diseased  process,  by  the  apparent 
external  integrity  of  the  horny  box. 

The  characteristic  of  canker  is  its  tendency  to  sj^read,  like  can- 
cerous affections.  Once  manifested  in  any  part  of  the  sub-horny 
tissues,  the  special  changes  which  characterize  the  disease  seldom 
remain  circumscribed;  on  the  contrary,  they  generally  extend 
from  that  part  as  a  centre,  throughout  the  whole  circumference, 
and  little  by  little,  attack  slowly  but  continuously  the  whole  ex- 
tent of  the  secreting  apparatus,  and  thus  loosen  the  entire  horny 
box — starting  from  the  median  lacunse,  or  the  glomes  of  the  frog, 
it  extends  to  the  branches  and  the  body  of  the  plantar  cushion  ; 
then  spreads  at  the  side,  in  the  lateral  laminae,  from  there  all  roimd 
on  the  velvety  tissue,  then  by  degrees  reaches  the  inferior  ex- 
tremity of  the  podophyllous  laminte  and  going  upward,  reaches 


DISEASES.  595 

the  coronary  band,  the  h\st  point,  where,  in  extreme  cases,  the 
hoof  preserves  its  adhesions  with  the  tissues  which  form  it.  In 
this  condition  the  disease  process  progresses  more  slowly  than  be- 
tween the  sole  and  the  velvety  tissue,  and  then  it  seems  to  remain 
stationary ;  otherwise  the  dropping  of  the  hoof  would  be  possible. 
We  have  seen  that  often  at  the  beginning,  but  especially  as  the 
disease  progresses,  there  are  growths  called  fici,  found  principally 
round  the  laminae,  the  frog  and  the  sole.  These  are  of  whitish 
color,  opal,  var^-ing  in  size  and  in  shape ;  they  constitute  an 
irregular  mass,  formed  of  those  fici  pressed  together ;  some  of 
these  growths  have  a  wide  basis,  others  are  somewhat  peduncu- 
lated ;  sometimes  they  are  single,  tubercular,  slightly  elevated ;  at 
other  times  elongated  bodies,  true  fibrous  bundles.  The  fici  are 
nothing  more  than  the  normal  villosities  of  the  keratogenous  tissue 
which  have  become  tumefied  and  hypertrophied,  and  are  found 
principally  where,  in  the  normal  state,  the  villosities  of  the  velvety 
tissue  are  themselves  more  numerous  and  more  developed.  "Where 
these  vegetations  are  confluent,  as  upon  the  sharp  edge  of  the 
bone,  they  are  separated  from  each  other  by  a  kind  of  deep  sinu- 
ous grooves,  filled  with  the  caseous  matter  secreted  by  the  diseased 
keratogenous  structure.  These  growths  bleed  easily  and  grow 
rapidly  again  when  excised.  Those  most  developed,  and  which 
seemed  to  form  a  homogeneous  mass,  constitute,  however,  an 
aggregate  of  smaller  vegetations  united  in  a  certain  part  of  their 
extent,  and  continued  at  their  bases. 

Besides  the  vegetation  of  the  living  tissues,  the  jjlantar  sur- 
face of  the  foot  presents,  in  old  cankers,  isolated  fasciculi  of  soHd 
homy  substance,  of  thready  appearance,  soft,  analogous  in  their 
form  to  coarse  brushes  whose  hairs  are  glued  together.  These 
isolated,  still  adherent,  brushes  are  seen  spreading  toward  the 
sole ;  they  correspond  with  j^arts  of  the  velvety  tissue  which  have 
maintained  their  soundness  in  the  midst  of  the  diseased  surface, 
and  there  continue  to  secrete  healthy  hoof.  These  horny  growths 
are  ordinarily  multiple,  and  are  of  various  shaj^es,  often  twisted, 
and  give  to  the  plantar  surface  a  peculiar  asj)ect,  so  much  so,  that 
then*  brushy  masses  sometimes  retain  the  mud  of  the  streets  and 
are  filled  at  their  bases  with  a  black  and  fcetid  substance  of  an 
ugly  appearance. 

^Tien  canker  has  amved  at  a  very  advanced  period,  it  is  char- 
acterized by  the  deformity  of  the  whole  horny  box,  whose  length 


596  OPERATIONS    ON    THE    FOOT. 

and  width  is  considerably  increased.  The  last  of  these  conditions 
is  a  sure  sign  that  the  disease  has  spread  under  the  wall  of  the 
quarters  and  of  the  heels,  and  has  produced  the  complete  separa- 
tion of  the  bars  from  above  and  below.  When  percussed,  the 
hoof  at  the  heels  gives  a  duU  sound.  The  excessive  length  is  only 
an  indirect  consequence  of  the  disease,  and  is  due  to  the  fact 
that,  so  as  to  keep  the  animal  at  work,  the  walls  are  spared  as 
much  as  possible  by  the  blacksmith,  so  as  to  avoid  the  contact  of 
the  protruding  parts  with  the  ground. 

Physiological  signs  are  almost  entu'ely  absent  in  canker.  It 
is  a  curious  fact  that  the  sensibihty  which  is  generally  highly  in- 
creased in  all  affections  of  the  foot,  even  in  chronic  diseases,  re- 
mains always  so  obscure  in  canker  that  animals  may  be  used  for 
a  long  time  without  lameness,  though  the  sub-horny  tissues  have 
become  quite  unprotected  over  a  large  surface. 

Complications. — Very  frequently,  canker  is  complicated  by  a 
disease  of  the  skin,  analogous  to  it,  known  as  grease ;  a  disease 
which,  if  not  entirely  of  the  same  nature,  as  admitted  by  Plasse, 
Megnin,  etc.,  is  closely  related  to  it.  It  is  often  through  this 
that  canker  begins,  and  very  often  the  two  diseases  exist  together 
in  the  same  animal,  one  sometimes  following  the  other,  just  as 
canker  of  one  foot  follows  that  of  another. 

Among  the  complications  of  canker,  as  generally  admitted,  are 
some  injui'ies  of  the  plantar  cushion :  inflammation  and  necrosis 
of  cartileges,  ligaments  or  tendons,  and  even  caries  of  the  os  pedis 
and  anchylosis,  which  are  sometimes  observed ;  however,  a  close 
examination  of  the  facts  allows  us  to  say  that  these  accidents  do 
not  arise  under  the  simple  influence  of  the  disease  alone,  but  that 
they  are  due  to  the  improper  use  of  sharp  instruments,  of  the 
actual  cautery,  and  especially  of  potential  caustics.  As  La  Gueri- 
niere  said,  the  deep  lesions  of  tendons  and  of  the  os  pedis,  which 
are  observed  in  severe  cankers,  have  no  other  cause  than  the 
action  of  too  powerful  dessicatives. 

Duration,  march,  termination. — Canker  is  an  essentially  chronic 
disease,  and  may  be  of  long  continuance,  even  lasting  for  years. 
Still,  under  this  heading  there  are  many  variations,  whose  cause 
it  is  difficult  to  find.  There  are  horses  whose  disorganization  of 
the  hoof  is  complete  after  two  or  three  months.  There  are  others 
where  the  disease  remains  stationary  for  more  than  a  year.  We 
have  seen  it  remaining  limited  to  one  lacuna  for  months,  and  all 


DISEASES.  597 

at  once  assume  a  rapid  evolution  of  disorganization.  We  have 
noticed  this  principally  after  the  use  of  sharp  instruments. 

Generally,  animals  affected  with  canker  feed  well,  and  for  a 
long  time  retain  a  good  condition  ;  toward  the  end,  however,  they 
lose  flesh  and  exhibit  symptoms  of  sejjticohemia,  especially  if 
affected  with  grease.  We  do  not  admit  that,  as  advanced  by 
some,  canker  can  give  rise  to  such  virulent  diseases  as  glanders 
and  farcy. 

Diagnosis. — At  the  beginning,  canker  may  be  confounded 
with  thrushes,  and  many  veterinarians  have  considered  this  as  the 
first  stage  of  canker.  There  is,  however,  a  great  difference  be- 
tween the  two :  first,  as  to  the  anatomo-pathological  point  of 
view,  inasmuch  as  the  pultaceous,  foetid  secretion  is  less  abund- 
ant ;  that  the  loosening  of  the  hoof  is  less,  and  that  there  are  no 
fici;  and  again,  especially  in  the  point  of  view  of  the  treatment, 
where  single  cases  of  cleansing,  with  or  without  dessicatives, 
easily  control  it,  while  canker  remains  rebellious  to  them. 

Prognosis. — The  prognosis  varies.  Where  the  animal  is 
young,  well  fed,  and  the  disease  is  not  too  old,  it  is  favorable. 
Yet  it  remains  uncertain,  as  often  the  most  benign  form  may  last 
long  and  remain  rebellious  to  all  treatment.  The  severity  and  the 
extent  of  the  internal  lesions  cannot  be  estimated  by  the  altera- 
tions or  deformities  of  the  hoof,  as  these  appearances  are  often 
deceptive.  Canker,  though  considered  incurable  for  a  long  time, 
is  not  absolutely  so — far  from  it ;  with  rational  treatment,  prop- 
erly carried  on,  it  is  curable  in  the  majority  of  cases.  There  are 
cases,  however,  not  very  rare,  where  relapses  and  useless  attempts 
have  discouraged  the  owner  ^s  well  as  the  veterinarian,  and  where 
it  has  been  more  advantageous  to  destroy  the  animal  rather  than 
to  submit  him  to  a  long,  tiresome,  and  always  expensive  treat- 
ment. 

Pathological  Anatomy  and  Nature  of  the  Disease. — It  has 
always  been  considered  that  a  morbid  condition  susceptible  of 
producing  disorders  so  severe  as  those  produced  by  canker,  must 
necessarily  be  a  deep  affection,  essential  and  important  to  the 
organic  structure,  and  depending  on  a  complete  transformation  in 
its  texture.  And,  indeed,  it  is  the  impression  which  predominated 
from  the  time  of  SoUeysel  down  to  the  foundation  of  veterinary 
schools  and  which  still  exists  with  Girard,  who  considers  canker 
as  a  gnawing  ulcer  which  changes  and  alters  the  tissues  it  invades, 


598  OPERATIONS    ON    THE    FOOT. 

and  even  with  Vatel  and  Hurtrel  d' Arboval,  who  looks  upon  canker 
as  the  carcinoma  of  the  reticular  structure  of  the  foot. 

It  is  but  recently  that  these  ideas  have  been  abandoned.  Du- 
puy,  in  1827,  considered  canker  as  a  hy^Dertrophy  of  the  fibres  of 
the  hoof,  admitting  at  the  same  time  the  disintegrations  and 
softening  of  those  same  fibres  occasioned  by  an  ammoniacal  sap- 
onization  produced  by  an  altered  secretion. 

In  1841,  Mercier  expressed  the  opinion  that  canker  is  nothing 
more  than  a  chronic  inflammation  of  the  reticular  tissue  of  the 
foot,  characterized  by  diseased  secretions  of  this  apparatus. 

It  is  now  known  that  there  is  in  canker  no  essential  alterations 
of  the  sub-horny  tissues ;  no  radical  change  of  their  substance, 
and  no  deposit  of  heteromorphous  molecules  in  theu*  structure. 
This  last  mentioned  fact  was  well  observed  by  Kobin,  who  in  his 
microscopical  remarks  constantly  observed  the  absence  of  the 
characterizing  elements  of  canker.  Hertwig  and  Haubner,  who 
have  made  researches  in  the  same  direction,  arrived  at  the  same 
result  and  have  noticed  the  absence  of  any  cancerous  cells  in 
canker.  This  opinion  is,  however,  doubted  by  GHsberg  and  Fuchs, 
who  look  ujDon  canker  as  an  epithelioma,  though  they  bring  no 
sufl&cient  evidence  to  establish  it. 

Except  vegetal  parasitism,  of  which  we  will  speak  hereafter, 
and  which  makes  of  canker  a  true  dartre,  an  herpetic  disease,  as 
demonstrated  by  Megnin,  there  is  only  in  canker  a  chronic  in- 
flammatory condition  of  the  sub-horny  tissues  which  is  mani- 
fested by  a  perversion  in  their  secretion,  and  is  complicated  by 
a  morbid  hyj^ertroj^hy  of  the  villous  processes  by  which  their  sur- 
face is  normally  covered.  Eobin  has  seen  in  the  fici,  papillae  made 
thicker  and  more  brittle  by  the  plastic  infiltration  which  moistens 
them;  he  has  observed  besides,  that  at  the  points  where  the  secre- 
tion is  good,  it  is  so  active,  that  instead  of  drjdng  in  sheaths,  to 
scale  off  afterward  in  transverse  pieces,  as  normally  occurs  in  the 
frog  and  sole,  the  epithelial  cells  grow  lengthwise,  as  those  which 
form  the  walls  of  the  foot.  Hence  these  long,  horned,  twisted 
threads  (epithelioma?)  which  are  seen  rising  from  the  sole  of  long 
affected  cankerous  feet. 

It  has  sometimes  been  admitted  that  fici  had  deep  roots  in  the 
tissues,  and  even  in  the  plantar  aponeurosis,  which  is  an  eiTor ; 
injections  and  macerations  ha\ang  shown  that  there  are  no  essen- 
tial changes  in  the  anatomical  structiu'es  of  these  parts,  and  that 


DISEASES.  599 

what  have  been  considered  as  the  roots  of  fici  were  only  cellular 
tissues,  which  has  become  indurated  under  chronic  inflammation 
(Bouley).  Fici  are  only  fasciculi  of  villosities  whose  vascular  net- 
work is  no  longer  retained  by  the  thick  horny  box  which  encloses 
them  and  which  is  infiltrated  with  plastic  material. 

Boioley  has  already  admitted  that  canker  could  not  be  better 
classified  than  among  skin  diseases,  with  and  after  dartroid  affec- 
tions, and  thus  gave  reason  to  Huzard  senior;  Plass  also  found 
that  canker  had  the  greatest  analogy  with  grease,  and  that  in  it 
the  nutrition  of  the  horn  underwent  the  same  alteration  with  nu- 
trition of  hairs  in  the  second  affection. 

Megnin,  in  1864,  observed,  in  operating  upon  fresh  pieces 
taken  from  the  hving  animal,  and  from  one  which  had  not  received 
any  treatment,  that  in  canker  there  is  constantly  a  cryptogam,  as 
in  favus,  and  that  canker  is  a  parasitic  affection. 

Examining  the  caseous  product  of  the  abnormal  secretion  which 
characterizes  canker,  Megnin  found  in  it  a  large  quantity  of  very 
animated  vibrios,  swimming  in  a  liquid  having  in  suspension  nu- 
merous epidermic  cells  more  or  less  advanced  in  dissolution ;  he 
found  besides  rounded  corpuscles,  which  he  recognized  as  the 
spores  of  the  cryptogam,  and  from  which  the  vibrios  escaped  at 
the  matuiity  of  the  granulations  there  contained.  In  examining 
the  fici,  he  has  recognized  them  to  be  an  aggregate  of  hypertrophied 
villosites,  at  the  base  of  which  were  found  in  the  mass  obtained 
by  a  slight  scraping  epidermic  cells  or  parts  of  cells  enclosed  in  a 
net-work  of  inter-crossed,  ramified  threads,  aj)pearing  to  rise  from 
certain  centers  marked  by  an  agglomeration  of  spores,  forming  in 
their  whole  a  yellow  spot.  In  the  water  of  the  microscopic  prep- 
arations, one  finds  also  several  of  these  isolated  threads,  epithelial 
cells,  globules  of  lymph,  of  blood  and  finally  spores  ;  very  rarely 
vibrios  ;  of  tener  micrococci.  These  threads  are  nothing  more  than 
the  parasites,  the  myceHum  product  of  the  vegetation  of  the 
spores ;  those  contained  in  the  serosity,  swell,  break  up,  and  the 
granulations  which  escape  from  them  become  for  some  time  the 
vibrios,  or  as  we  prefer  to  call  them,  pseudo-vibrios ;  as  soon  as 
the  brownian  motion,  which  for  some  time  animates  the  granula- 
tions, ceases,  the  cells  which  have  proceeded  from  them  (the  micro- 
cooci)  gather  together  in  chains  and  form  the  characteristic  threads 
of  the  myceHum. 

This  parasite  of  canker  has  been  named  by  Megnin  the  kera- 


GOO  OPEKATIONS    ON    THE    FOOT. 

phyton  or  parasitic  plant  of  the  horn,  by  analogy  with  the  tricho- 
phyton, the  parasite  of  the  hair.  We  consider  this  name  very 
apj)ropriate  and  prefer  it  to  the  name  of  odium  batracosis,  parasite 
of  the  canker,  which  Mr.  Megnin  has  also  proposed. 

Etiology. — The  causes  of  canker  are  yet  but  little  known ; 
there  is  one,  however,  which  cannot  be  ignored,  and  which,  if  it 
does  not  produce  the  disease,  assists  materially  in  its  develop- 
ment and  is  indisjDcnsable  to  its  existence.  We  refer  to  the  con- 
dition of  damj)ness.  It  is  that  influence  of  dampness  which 
explains  why  the  disease  is  so  very  common  in  the  marshy  lands  of 
Poitou  ;  in  the  pastures  of  Holland,  and  in  general  in  low  grounds  ; 
and  why  it  is  more  frequent  in  northern  than  in  southern  coun- 
tries. Canker  is  incomparably  more  frequent  in  rainy  seasons  than 
in  those  where  dryness  predominates.  We  have  already  seen  in 
the  history  of  the  disease  that  it  is  since  the  streets  and  the  stables 
of  administration  are  kept  more  free  from  damj)ness  that  canker 
has  become  less  common. 

Sometimes  the  action  of  direct  irritating  causes  has  been 
admitted,  and  then  the  canker  has  been  attributed  to  irritating 
muds  and  the  excrementitial  liqu.ids  of  stables  ;  their  contact  often 
giving  rise  upon  the  skin,  upon  the  glomes  of  the  frog,  to  an  ery- 
thematous inflammation,  soon  followed  by  a  serous  flow,  which  ex- 
tends to  the  sub-horny  structures  and  gives  rise  to  an  exudation 
in  the  laminse  of  the  frog.  This  cause  produces  the  rotten  frog 
(thrushes)  but  not  canker.  We  beheve  that  this  cause  has  princi- 
pally been  admitted  by  veterinarians  who  look  upon  thrushes  as 
the  first  stages  of  canker,  but  this  is  not  so,  and  for  canker  to 
develop  itself  under  similar  conditions,  others  are  necessary,  which 
are  as  yet  unknown. 

Canker  has  also  been  attributed  to  narrow  and  contracted  feet, 
so  common  in  horses  of  meridional  climates,  and  in  which  the  sole 
is  very  concave,  with  the  frog  and  pyramidal  body  shrunk  in. 
Often  in  the  laminse  of  these  feet  a  sero-purulent  moisture  is  dis- 
covered, more  or  less  offensive,  which  is  a  rotten  frog,  but  not 
canker,  and  but  seldom  followed  by  it. 

To  produce  canker  a  simple  irritation  of  the  sub-horny  struct- 
ure is  not  sufficient.  There  must  be  a  special  cause,  proper  to 
canker,  stimulating  alone  the  characteristic  changes  of  the  cause. 
This  cause  we  find  in  the  cryptogam  which  characterizes  canker, 
propagates  it,  and  which  has  no  power  of  spontaneous  existence. 


DISEASES.  'GOl 

As  with  other  parasitic  diseases,  canker  is  communicable  by 
contagion  ;  although  the  examples  are  quite  rare  they  cannot  be 
doubted.  Hutrel,  d'Arboval,  Plass,  Blind  and  Megnin  have  ob- 
served them,  and  in  all  the  cases  dampness  has  contributed  to 
the  propogation  of  the  cryptogam. 

The  lymphatic  constitution  in  an  animal  is  eminently  propi- 
tious to  the  development  of  canker,  as  it  is  observed  to  be,  in  fact, 
for  all  parasitic  diseases. 

It  is  known  by  daily  observation  of  facts  that  horses  whose 
sldn  is  thick,  with  the  hahy  system  well  developed,  the  feet  flat, 
with  thick  frogs,  are  more  often  affected  with  canker  than  animals 
of  a  nervous  constitution.  It  is  more  particularly  observed  in 
horses  with  much  white  at  their  extremities,  with  stockings  and 
white  feet,  and  in  those  where  there  is  a  tendency  to  albinism. 

An  unknown  diathesis  has  also  been  considered  as  causing  a 
predisposing  constitutional  organic  condition,  but  this  has  not 
been  justified  by  observation.  It  may  happen  that  canker  cured 
or  dried  on  one  foot,  may  attack  another  foot,  perhaps  a  third, 
and  then  a  fourth,  to  re-appear  in  the  first ;  this  chai'acter  of  the 
disease  has  often  been  mentioned  as  proof  of  this  diathesic  condi- 
tion ;  but  it  may  also  be  explained  by  its  contagious  character. 
The  disease  remains  too  much  localized  to  be  constitutional,  as 
generally  in  diathesic  diseases  we  have  critical  eruptions  upon 
different  organs  or  different  tissues. 

Treatment. — From  the  preceding  remarks,  it  is  evident  that 
in  feet  affected  with  canker,  the  keratogenous  ajjparatus  of  the 
foot  has  undergone  no  essential  alteration  in  its  structure,  that  its 
thickness  and  density  have  only  increased  by  consequence  of  the 
infiltration  and  organization  in  its  net-work  of  the  plastic  products 
of  inflammation.  And,  again,  the  secreting  function  of  this  appa- 
ratus, far  from  being  arrested,  is  on  the  contrary,  more  active ;  but 
the  products  it  gives  instead  of  being  concrescible,  remain  difflu- 
ent ;  hence  the  impossibility  for  the  hoof  to  be  restored  in  the 
regions  where  this  alteration  of  secretion  exists  and  remains. 
These  important  facts,  says  M.  Bouley,  must  take  the  lead  in  the 
chapter  of  the  therapeutics  of  canker,  because  they  teach  the 
practitioner  that  the  object  to  effect,  in  the  treatment  of  this  dis- 
ease, is  not  to  radically  destroy  the  diseased  tissues,  as  has  been 
too  often  done  and  recommended,  but  to  return  to  them  their 
physical  and  physiological  properties  by  the  application  on  their 


602 


OPERATIOXS    ON    THE    FOOT. 


surface,  of  modifying  agents  which  influence  the  nutritive  and 
secreting  functions  of  their  tissues  without  interfering  with  their 
structiu-e.  To  reach  this  point,  the  most  varied  pharmaceutical 
agents  have  been  recommended,  the  most  successful  being  those 
which  at  the  same  time  had  parasiticide  properties.  We,  however, 
find  it  difficult  to  give  the  preference  to  any  of  them ;  and  we  have 
now  more  faith  in  the  modus  faeiendl,  to  the  skill  of  the  operator, 
to  the  continued  use  of  dressings  properly  applied,  than  to  such 
or  such  agent ;  all  of  those  which  have  been  recommended  if 
methodically  appUed,  can  cure  canker,  and  it  will  be  wise  to  em- 
ploy them  alternatively ;  when  one  fails  at  first  it  is  prudent  to 
try  another ;  canker  is  a  disease  so  often  rebellious  to  treatment, 
especially  when  confined  to  the  lacunae  of  the  frog,  that  too  many 
remedies  cannot  be  used. 

The  first  indication  is  to  remove  the  excess  of  the  horn  of 
the  waU,  the  length  of  which,  we  have  said,  is  often  very  great; 
then  prepare  a  convenient  shoe  for  the  dressings.  This  shoe  nec- 
essarily varies,  as  canker  is  exclusively  locaHzed  to  the  plantar 
surface  of  the  foot  or  extends  to  the  podophyllous  laminae.  Gen- 
erally an  ordinary  shoe  is  used,  more  or  less  covered  (wide)  and 
so  hoUowed  as  to  aUow  the  free  application  of  plates  by  which 
the  dressing  is  kept  in  place.  "When  the  condition  of  the  disease 
requires  the  removal  of  large  pieces  of  horn,  a  truncated  slipper 
is  used,  proportioned  in  cutting  to  the  extent  of  the  parts  of  the 
wall  upon  which  it  is  to  be  applied.  There  are  circumstances  even 
when  shoes  cannot  be  used,  so  much  does  the  disease  extend 
under  the  waU.  It  is  then  necessary  to  use  a  shoe  without  nails,  or 
boots,  secured  to  the  coronet  by  means  of  straps.  In  all  cases  the 
rule  is  to  take  care  that  the  dressings  remain  fixed  in  the  most 
exact  manner,  and  that  through  them  a  methodic,  steady,  but  not 
excessive  pressure  is  constantly  appHed  over  the  diseased  parts. 

The  first  step  of  the  operation  passed,  the  next  consists  in 
the  removal  with  proper  instruments  of  aU  the  loose  portions  of 
the  horn,  either  at  the  plantar  surface,  at  the  quarter,  or  at  the 
heels.  One  must  avoid,  in  this  ojoeration,  the  excision  of  soft 
parts ;  but  the  important  indication  is  to  follow  the  disease  where- 
ever  it  exists,  and  to  leave  no  part  of  the  horn  which  may  have 
been  detached  by  morbid  exudations.  Better  cut  the  healthy 
structures,  and  have  them  bleed,  than  to  neglect  to  completely 
expose  a  diseased  part.     This  done,  the  horn  is  to  be  thinned  as 


DISEASES.  603 

much  as  possible,  upon  the  circumference  of  the  diseased  spots,  in 
order  to  give  a  supjDleness  which  would  ease  the  swelling  of  the 
uncovered  parts. 

Upon  the  exposure  of  the  disease  where  it  exists,  the  fici  exist- 
ing on  the  surface  and  edges  of  the  velvety  tissues  are  to  be 
removed  with  the  scissors  or  sharp  sage  knife ;  at  the  same  time 
the  parts  of  horn  which  may  have  remained  are  to  be  cut  off, 
avoiding,  however,  the  healthy  tissue  beneath,  which  still  retains 
its  normal  character. 

When  the  canker  is  very  extensive,  so  that  the  wall  is  loose  on 
each  quarter,  or  on  all  its  circumference,  it  is  of  advantage  to  pro- 
ceed in  the  required  operations  at  different  times. 

This  done,  the  shoe  can  be  put  on ;  after  which  the  diseased 
surface  and  surrounding  horn  are  to  be  covered  with  a  thick  layer 
of  the  medicamentous  preparation.  If  this  is  in  form  of  a  paste,  as 
is  often  the  case,  it  is  sjoread  over  with  a  spatula.  If  in  powder, 
it  is  thrown  over  it  carefully.  If  liquid,  balls  of  oakum  are  soaked 
with  it  and  placed  on,  the  whole  being  then  kept  in  place  by  pads 
and  plates.  The  important  point  is  that  the  dressing  should  be 
so  appHed  as  to  be  easily  changed,  that  an  exact,  regular  and 
sufficiently  strong  pressure  be  kept  on.  No  better  means  can  be 
used  for  this  than  the  divided  plates  already  referred  to. 

In  canker  the  dressing  must  be  renewed  every  day,  and  even 
twice  daily  at  the  beginning  of  the  treatment.  This  is  an  essential 
condition  of  success,  whatever  may  be  the  therapeutical  agent 
employed ;  and  this  is  not  a  simple  difficulty  in  practice  where  the 
patient  is  not  always  of  easy  access.  Moreover,  this  dressing  is 
somewhat  complicated,  and  can  only  be  skillfully  made  by  the  vet- 
erinarian himself. 

It  often  occurs  that  upon  the  removal  of  the  first  dressing,  (the 
second  day)  one  finds  the  tissues  already  covered  by  a  layer  of 
hardened  horn,  adherent  to  the  surfaces.  One  must  then,  with 
the  finger,  a  spatula,  or  a  di-y  pad  of  oakum,  rub  it  off  where  it  is 
found  loose  and  movable  and,  if  necessary,  renew  the  application 
of  the  dressing.  The  same  must  be  done  at  the  other  dressings, 
carefully  watching  if  this  new  horn  thus  formed  by  the  influence 
of  the  medication,  is  not  separable  from  the  parts  underneath  by 
the  different  morbid  secretions  of  the  disease.  One  must  then 
carefixlly  scrape  off  all  that  is  not  adherent,  and  thin  the  edges, 
and  the  projections  of  all  the  horn  which  retains  its  soundness; 


604  OPEEATIONS    ON    THE    FOOT. 

the  caseous  substance  being  also  removed  ;  the  same  compressive 
dressing  to  be  put  on  again. 

The  modification  in  the  horny  secretion,  and  the  formation  of 
a  layer  of  hardened  and  adherent  horn,  are  especially  great  in  the 
parts  where  podophyllous  and  velvety  tissues  exist ;  but  are  very 
slow,  and  surrounded  with  difficulties  in  the  median  and  lateral 
lacunse  of  the  frog.  After  ten  days  of  treatment,  one  may  have 
brought  about  a  normal  secretion  on  the  whole  circumference  of 
the  sole,  on  the  inferior  face  of  the  os  pedis,  and  on  the  prominent 
parts  of  the  pyramidal  body.  But  in  the  lacunse  the  alteration 
remains  isolated,  and  resists  treatment-;  and  it  often  happens  that, 
if  neglected,  it  may  again  sj)read  and  the  disease  reach  its  former 
extent.  It  is  then  the  case,  when  the  disease  is  limited  to  the 
lacunse,  to  add  to  the  ingredient  already  in  use  and  which  is  kept 
api^lied  upon  the  restored  parts,  another  stronger  and  more  active 
agent,  sometimes  simply  absorbent;  here  again  it  becomes  diffi- 
cult for  us  to  advise  the  practitioner,  the  number  of  recommended 
drugs  being  very  large  and  the  result  depending  less  on  their 
nature  than  in  the  intelligent  and  persisting  manner  with  which  it 
is  apphed.  When  caustics  are  used,  it  must  be  done  with  great 
care,  to  Umit  their  action  only  to  the  thickness  of  the  keratogen- 
ous  tissue,  and  not  to  carry  it  to  the  destruction  of  the  bone,  or 
still  worse,  of  the  plantar  aponeurosis. 

Let  us  glance  at  the  drugs  which  have  proved  most  successful 
in  the  treatment  of  canker :  First  we  have  the  different  pyrogen- 
ous  preparations,  especially  wood  tar,  recommended  by  Bracy, 
Clark,  Eeynal  and  Bouley,  and  which  give  astonishing  results.  Gas 
tar,  oil  of  cade,  petroleum  and  soot  have  also  been  used,  but  with 
less  advantage  ;  creosote  and  phenic  acid  have  often  shown  them- 
selves very  useful,  by  penetrating  easier  to  the  base  of  the  villosities 
where  the  parasite  resides  and  thus  acting  more  regularly ;  phenic 
acid  proved  very  useful  with  Krause,  Gerlach  and  Zundel. 

After  these  the  best  recommended  preparations  are  the  salts  of 
iron.  Hertwig  seems  to  be  well  pleased  with  the  powder  of  sul- 
phate, and  Ai-nold  recommends  the  pyrohgnite  of  the  same  metal ; 
Megnin  advises  sj^ecially  the  perchloride,  which,  like  phenic  acid, 
is  rather  a  powerful  astringent  than  a  true  caustic.  The  jjrepar- 
ations  of  copper  have  also  had  their  time,  and  es^Decially  the  aceta- 
tes, such  as  the  cegyptiacum  ointment  (Girard,  Schaack,  Kainard 
and  Key) ;  the  baths  of  sulphate  of  copper  were  employed  by 


DISEASES.  605 

Verrier,  Jr.,  of  Rouen;  a  solution  of  sulphate  of  copper  and  of 
zinc  in  water  or  vinegar  were  recommended  by  Delaval  and  Haub- 
ner ;  Solleysel  emj)loyed  the  j)reparations  of  copper,  but  added  to 
them  arsenic  and  other  di'ugs  ;  Eichbaum  preferred  the  powder  of 
chloride  of  lime,  and  Eauch  ordinary  hme,  while  Aubry  employed  a 
mixture  of  Ume  and  caustic  potash. 

Caustics  were  well  recommended  by  other  practitioners,  but 
their  prescriptions  seem  to  be  contraxy  to  the  rule  we  have  laid 
down  in  the  beginning.  However,  one  must  not  forget  that  the 
tissues  of  the  foot,  especially  when  diseased,  offer  an  extraordinary 
resistance  to  the  action  of  caustics  ;  they  are,  so  to  speak,  impene- 
trable, and  the  irritation  they  produce  remains  superficial,  while 
where  those  tissues  are  healthy  such  agents  produce  a  deep  cau- 
terization. Again,  this  resisting  force  of  the  indurated  tissues 
against  the  actions  of  caustics  is  limited,  and  it  is  possible  that 
one,  two  or  three  applications  may  apparently  remain  inefficacious, 
where  a  fourth  or  a  fifth  will  give  rise  to  extensive  cauterization.  The 
result  is  explained  by  the  repeated  u-ritating  influence  of  the  caustic 
agent,  which,  by  gradually  increasing  the  vascularity  of  the  parts  it 
touches,  increases  also  the  means  of  their  absorption  and  imbibition. 
These  facts  must  also  be  present  to  the  practitioners  mind,  and 
it  is  by  them  that  he  will  be  guided  in  their  use,  rendering  them 
at  will,  simply  modifying,  catheretic,  or  deep  caustics. 

Nitric  acid  was  used  by  Percivall  and  Delorme,  the  latter  con- 
sidering it  the  best  means  in  use.  Sulphuric  acid  has  also  been 
employed,  seldom  alone,  but  mixed  with  agents  likely  to  reduce 
its  effects  and  render  its  applications  more  convenient.  CoUignon 
and  Renault  recommend  its  reduction  with  alcohol ;  Mercier 
mixed  it  with  four  parts  of  oil  of  tui-pentine  ;  Prangc  with  equal 
parts  of  tar,  and  Plass  made  a  paste  of  it  with  burnt  alum.  This 
last  remedy,  very  simple  in  its  foi-mula,  was  applied  without  any 
dressing  ;  it  has  proved  most  excellent  in  a  great  number  of  cases, 
but  may  give  rise  to  too  deep  cauterization  (Bouley,  Mendel). 

Arsenious  acid  was  much  used  by  old  horsemen,  combined  with 
cegyptiacum,  tui-pentine  and  other  ingredients.  Hoffmann  prefers 
the  arsenite  of  soda  in  solution  ;  he  sold  his  secret  to  the  Austrian 
government  for  a  high  price.  Butter  of  antimony  was  recom- 
mended by  Huzard  Sr.,  Prevost,  and  especially  Huzard  ;  chloride 
of  zinc  was  preferred  at  the  Lyons  school. 

The  treatment  of  canker  by  actual  cauterization  was  indicated 


GOG  OPERATIONS    ON    THE    FOOT. 

by  Solleysel,  but  soon  abandoned  by  him.  In  applying  the  cau- 
tery upon  the  uncovered  tissues  of  the  hoof,  we  encounter  the 
chance  of  producing  a  very  severe  inflammation,  which  spreads  by 
degrees  and  gives  rise  to  extensive  slough  of  the  hoof,  as  a  con- 
sequence of  the  serious  exudation  which  takes  place ;  the  action 
of  the  cautery  may  then  become  either  too  mild  or  too  vigorous. 
Still,  it  has  been  recommended  by  Prevost,  of  Geneva.  Hurtrel 
d'Arboval,  who  also  employed  it,  used  it  in  the  following  manner: 
the  parts  being  covered  with  a  mixture  of  gunpowder  and  sulphur, 
a  red-hot  iron  was  applied  to  the  spot,  the  powder  burning  sud- 
denly and  the  sulphur  slowly.  If  the'  combustion  was  too  slow, 
he  increased  it  and  kept  it  up  by  the  same  means.  "When  the 
ojDeration  is  concluded  the  parts  are  transformed  into  a  black  scar, 
which  can  be  easily  removed  by  scraping,  and  the  application  and 
cauterization  may  be  repeated,  and  so  on  until  it  appears  that  a 
sufficient  amotmt  of  heat  has  penetrated  the  tissues  to  destroy  the 
material  by  which  canker  may  be  regenerated.  The  cauterization 
being  once  properly  effected,  then  in  order  to  sustain  irritation, 
the  foot  is  covered  with  Burgundy  pitch,  or  resin,  melted  and 
warm,  which  is  allowed  to  cool  off  on  the  foot,  when  a  dressing  of 
oakum  and  the  shoe  are  put  on.  The  dressing  is  changed  as  soon 
as  suppuration  shows  itself  and  renewed  with  the  same  ingredients 
in  the  same  manner  until  the  wound  becomes  healthy  and  granu- 
lating. 

It  is  only  for  the  sake  of  the  record  that  we  refer  to  the  ex- 
clusively surgical  treatment,  based  upon  the  erroneous  idea  that  the 
fici  of  canker  are  abnormal  products,  deejoly  implanted  in  the 
tissues  beneath,  and  where  it  was  advised  to  look  for  the  imagin- 
ary roots  of  these  fici  at  their  extreme  limits.  In  this  treatment, 
not  only  the  diseased  horn  was  removed,  but  the  entire  sole,  the 
plantar  cushion  and  often  the  plantar  aponeurosis  was  excised. 
This  practice,  advised  by  Lafosse  junior,  was  also  recommended 
in  the  veterinary  schools  by  Chabert  in  France,  and  Dieterichs  in 
Germany.  It  prevailed  for  a  long  time,  though  experience  showed 
that  the  wound  resulting  from  such  an  operation  was  of  very  slow 
recovery,  that  the  frog  especially  could  not  be  regenerated,  that 
there  remained  a  central  ulcer,  and  that  it  gave  rise  to  such  a  mal- 
formation of  the  foot  that  the  animal  remained  lame  for  a  long 
time,  sometimes  for  life.  Notwithstanding  these  objections,  ob- 
served by  Jeaune,  Girard  and  Eichbaum,  this  treatment  is  still 


DISEASES.  607 

followed  by  a  few  who  prefer  it  to  the  simple  operations  of  SoUey- 
sel,  which  consists  in  the  division  of  the  loose  pieces  of  horn  and 
the  excision  of  the  fungoid  projections. 

We  have  thus  far  only  spoken  of  the  local,  without  referring  to 
the  internal  or  constitutional  treatment  of  canker,  recommended 
by  those  who  look  upon  the  disease  as  constitutional.  "Without 
believing  that  it  can  have  any  real  curative  effect,  we,  however, 
admit  its  usefiilness,  when  the  disease  is  of  old  standing,  and  that 
the  animal  has  suffered  much  by  it.  Ferruginous  preparations 
are  specially  advisable,  and  we  prefer  the  carbonates  that  are  used 
by  Delwart  to  the  sulphates  recommended  by  Prevost,  Delaval 
and  Hertwig,  and  it  is  well  to  unite  them  with  bitters  and  tonic 
powders,  Arsenious  acid  is  prescribed  internally  by  Delaval, 
Feuillette,  Niederberger,  Obich ;  and  other  alteratives,  such  as 
mercury,  which  we  would  not  advise.  Nor  can  we  understand 
how  any  benefit  is  to  be  dei'ived  from  diuretics  and  purgatives, 
and  especially  from  the  use  of  external  emunctories,  such  as 
setons. 

Corns. 

Under  this  name  is  understood  an  alteration  of  the  tissues 
underneath  the  hoof ;  of  the  heels  of  the  horse's  foot  by  lesions  of 
the  li\dng  parts  in  the  movements  of  expansion  of  the  hoof ;  by 
bruises,  compressions  or  contusions.  There  is  then  a  capillary 
hemorrhage  which  extends  in  ecchymosis  in  the  hoof.  A  corn, 
then,  is  a  bruise  of  the  living  horn  at  the  extreme  end  of  the 
branches  of  the  sole,  and  especially  in  the  laminated  tissue  of  the 
folds  of  the  bars.  It  is  a  very  common  disease,  and  one  to  which 
all  horses  are  exposed.     Some  have  them  constantly. 

Corns  are  seen  mostly  on  the  fore  feet,  and  on  the  inside 
more  commonly  than  on  the  external  side.  They  are  rare  on  the 
hind  feet,  because  in  the  various  gaits  the  weight  of  the  body  is 
carried  more  on  the  front  legs  and  on  the  posterior  part  of  the 
foot,  while  in  the  hind  legs  it  is  the  front  part  which  principally 
receives  it. 

I.  Divisions. — Lafosse  Sr.,  has  distinguished  them  into  natural 
and  accidental,  while  Girard  considers  them  all  as  accidental.  H. 
Bouley  designates  as  essential  those  which  come  from  other  than 
external  causes.  We  believe  that  it  would  be  better  to  estabhsh 
the  divisions  on  pathological  and  anatomical  bases,  and  admit  a 


608  OPERATIONS    ON    THE    FOOT. 

corn  of  the  tvall,  or  laminated,  that  whicli  has  its  seat  in  the 
laminse  which  unites  the  wall  to  the  tissues  underneath,  viz.,  in 
the  keraphyllous  and  podophyllous  tissues  of  the  heels  and  bars, 
and  a  corn  of  the  sole,  or  velvety,^  that  which  has  its  seat  in  the 
velvety  tissue  which  unites  the  sole  to  the  fleshy  parts.  The 
laminated  corn  corresponds  exactly  to  the  "  natural "  of  Lafosse 
and  to  the  "  essential "  of  Bpuley.  It  is  due  to  lacerations  in  the 
movements  of  expansion  of  a  badly-made  foot.  The  other  is  due 
to  contusions.  "WTiatever  may  be  the  adopted  divisions,  we,  with 
Gn-ard,  and  as  admitted  in  practice,  recognize  in  each  category, 
the  dry,  the  moist  and-  the  suppurated  corn. 

II.  Etiology. — All  feet  are  exposed,  but  not  all  predisposed  to 
corns.  They  are  more  frequent  in  heavy  feet,  with  those  where 
the  heels  are  high  or  contracted  in  which  there  is  a  motion  of  re- 
traction of  the  hoof  which  interferes  with  the  displacement  back- 
ward of  the  third  phalanx  at  the  time  of  rest,  and  hence  the  lacera- 
tions are  easy ;  besides,  there  is  a  continual  pressure  upon  the 
living  parts  of  the  posterior  region  of  the  nail.  Corns  are  fre- 
quently observed  in  excessively  long  feet  where  the  hoof  does  not 
receive  the  moisture  necessary  to  its  elasticity  ;  it  then  losses  its 
suppleness  and  fails  to  assist  the  internal  motions  of  the  parts 
contained  within.  It  is  seen  whenever  the  hoof  is  too  dry,  the 
posterior  diameter  of  the  feet  being  then  diminished.  Corns  are 
seen  on  weak  feet,  on  which  the  hoof  is  too  thin  to  resist  the 
dilating  effect  of  the  internal  structure,  and  spreads  excessively. 
Wide  and  flat  feet,  with  low  heels,  in  which  the  interior  surface  of 
the  branches  of  the  sole  is  on  a  level  with  the  plantar  border  of  the 
quarters  and  bars,  are  very  often  affected  with  corns.  The  pres- 
sure of  the  shoe  or  the  roughness  of  the  ground  produce  these 
bruises  through  the  sole.  Here  the  conditions  are  unfavorable 
to  the  normal  dilatations  of  the  hoof ;  the  ungeal  phalanx,  being 
unsupported  by  the  convexity  of  the  sole,  has  a  tendency  to  drop 
down  lower,  the  tissues  are  easily  lacerated  and  bruised  in  its  dis- 
placement at  the  time  the  foot  rests  on  the  ground. 

The  most  serious  causes  of  corns  arise  from  the  shoeing,  which 
not  only  sometimes  gives  to  the  hoof  a  shape  predisposing  to  that 
disease,  but  also  very  often  is  a  determining  cause  itself  of  these 
injuries.  "  As  long,"  says  Hartmann,  "  as  horses  will  have  corns, 
horse-shoeing  cannot  pass  as  an  art,  and  their  too  frequent  pi-es- 
ence  is  an  e\ddent  proof  of  our  imperfect  means  of  protection  to 


DISEASES.  609 

the  hoof."  Without  shoeing  there  would  be  no  corns,  and  it  is  in 
its  irrational  methods  that  the  true  causes  of  these  accidents 
originate.  It  is  by  the  greater  or  less  frequency  of  corns  that  one 
may  judge  of  the  state  of  that  art  in  a  country. 

The  faults  are  found,  1st,  in  the  manner  in  which  the  foot  is 
pared,  or  in  the  shape  which  it  receives  ;  2d,  in  the  fitting  of  the 
shoe  ;  3d,  in  its  appHcation.  In  paring  the  foot,  the  sole  is  often 
weakened  and  thinned  too  much ;  it  does  not  resist  the  pressure, 
and,  at  the  time  of  resting  the  foot,  all  the  weight  of  the  body  is 
thrown  upon  the  point  of  union  of  the  sole  with  the  wall.  Ordi- 
narily too  much  has  been  cut  away  from  the  frog,  and  this  not 
resting  any  more  on  the  ground,  no  longer  resists  the  pressure, 
and  the  lowering  of  the  branches  of  the  sole  is  then  extreme,  as 
proved  by  the  experiments  of  Leisering.  The  custom  of  cutting 
the  corns,  and  of  cutting  the  hoof  at  the  heels,  acts  in  a  similar 
manner ;  the  posterior  half  of  the  foot  is  weakened,  and  that  is 
the  part  which  must  carry  the  greatest  part  of  the  w^eight.  One 
needs  only  to  compare  a  foot  from  which  the  shoer  has  removed 
much  horn  at  the  sole,  frog  and  bars,  with  one  in  which  the  hoof 
has  been  left  alone  for  a  long  time.  In  making  a  vertical  and 
tranverse  section  of  the  two  in  the  middle  of  the  frog,  a  little  in 
front  of  the  angles  of  the  sole,  he  will  see  at  once  how  weak  the 
point  of  reunion  of  the  sole  with  the  wall  has  become,  the  means 
of  resistance  to  the  pressure  of  the  weight  of  the  body  through 
the  thii'd  phalanx  being  thus  diminished,  and  consequently  a  pre- 
disposition to  bruises  created. 

The  shape  of  the  shoe  also  contributes  to  corns ;  an  excess  of 
concavity ;  a  shoe  which  from  the  last  nail-hole  is  not  flat  to  the 
heels,  whose  branches  are  too  much  inchned,  contributes  to  the 
lateral  contraction  of  the  foot  and  gives  rise  to  corns.  In  this  case 
the  shoe  resists  the  play  of  the  horny  box,  and  by  itself,  through 
the  sole,  exercises  a'  great  pressure  upon  the  tissues  underneath. 
Too  high  caulks,  in  preventing  the  resting  on  the  frog,  cause  an 
excessive  pressure  on  the  inside  of  the  foot,  and  compel  it  to  rest 
on  the  heels  and  the  branches  of  the  sole,  which  are  too  much 
lowered.  The  opposite  excess,  when  the  shoe  is  thin  at  the  heels, 
as  in  the  Coleman  shoe — which  is  thick  at  the  toe  and  thin  at  the 
heels — produces  a  similar  result,  because  in  increasing  the  pres- 
sure on  the  heels,  it  gives  rise  to  bruises  of  the  tissues  through 
the  retrossal  processes,  which  comes  down  too  heavily.     A  very 


610  OPERATIONS    ON    THE    FOOT. 

wide  slioe,  too  tliin,  may  also  contribute  to  the  genesis  of  corns, 
because,  then,  the  shoe  helping-,  with  the  intensity  of  the  reactions 
on  the  pavement  or  on  too  hard  and  stony  roads,  the  shoe  soon 
gives  under  the  foot,  and  compresses  the  sole  and  tissues  beneath. 

The  manner  in  which  the  shoe  is  put  on  may  also  be  a  cause 
of  corns  ;  the  shoe  ought  to  rest  exclusively  on  the  inferior  border 
of  the  wall,  and  not  touch  the  sole ;  when  it  is  too  narrow  it  may 
be  a  cause  of  contusion  or  of  contraction ;  if  too  wide  it  prevents 
the  natural  expansion.  It  is  upon  horses  long  shod  that  the  wrong 
apj)lication  of  the  shoe  as  a  cause  of  corns  is  observed.  As  a  con- 
sequence of  the  growth  of  the  hoof,  the  shoe  no  longer  sufficiently 
protects  the  plantar  border  of  the  foot,  the  heels  of  the  shoe  being 
inward  and  pressing  on  the  branches  of  the  sole ;  this  is  especially 
the  case  when  the  shoe  is  thinned  by  wearing  ;  it  yields,  and  easily 
bruises  the  parts  of  the  sole  on  which  it  rests ;  high  caulks,  on  a 
branch  already  too  short,  or  too  thin,  act  the  more  injuriously  be- 
cause, not  being  concentrated  on  the  projection  of  the  caulk,  the 
branch  gives  away  sooner,  and  presses  still  more  on  the  heels. 

The  shoe  becomes  an  indirect  cause  of  corns,  when  hard  sub- 
stances, as  stones  or  dry  earth,  are  found  between  its  superior  and 
inferior  face  on  the  sole,  or  between  the  frog  and  the  internal  bor- 
der of  the  branches  of  the  shoe ;  this  is  a  secondary  cause,  which 
was  formerly  considered  of  great  importance. 

The  work  of  horses  has  a  great  influence,  corns  being  very  fre- 
quent in  horses  which  work  on  pavements  and  stony  and  hard 
roads.  They  are  I'are  in  country  horses,  but  common  in  those  of 
great  cities  ;  a  rapid  gait  contributes  to  their  development  on 
account  of  the  great  pressure  on  the  ground.  The  seasons  have 
also  an  influence,  dry  and  warm  weather  depriving  the  hoof  of  its 
moisture,  and  by  preventing  its  elasticity  of  motion,  increasing  the 
effect  of  pressure  upon  the  tissues. 

Emigration  has  been  considered  a  cause  of  corns.  Horses 
coming  from  the  north  of  Germany  are  mentioned  as  having  been 
rapidly  affected  by  them  after  being  in  large  cities.  But  if  the 
change  too  suddenly  made  from  soft  "to  dry  bedding  is  an  effective 
cause,  the  mode  of  shoeing  can  also  be  considered  as  a  stimulating 
cause.  The  same  is  true  with  respect  to  the  African  horses,  which 
are  generally  free  from  the  disease  in  their  native  country,  but 
frequently  suffer  with  them  when  brought  to  France,  and  submitted 
to  a  mode  of  shoeing  so  different  from  that  of  the  Arabs. 


DISEASES.  611 

III.  jSi/mptonis. — The  ordinary  symptoms  of  corns  are  noticed 
in  the  abnormal  position  of  the  leg  at  rest,  in  the  lameness  and  the 
sensibility  of  the  region. 

When  lame  with  a  corn  the  horse  carries  the  leg  forward  of 
the  plumb  line,  and  keeps  it  semi-flexed  at  the  fetlock;  he  tries 
to  relieve  the  painful  region  by  resting ;  sometimes  he  manifests 
his  pain  by  pawing  and  moving  his  feet  from  forward  backward, 
pushing  his  bed  under  him.  The  lameness  is  not  characteristic  ; 
it  varies  greatly  in  intensity,  from  a  slight  soreness  to  lameness  on 
three  legs.  It  is  generally  proportioned  to  the  intensity  of  the 
disease.  However,  there  are  horses  so  accustomed  to  their  corns 
that  they  do  not  go  lame,  while  others  are  very  much  so  for  a 
trifling  injury.  Sometimes  it  is  intermittent,  and  diminishes  when 
the  suppui'ation  has  made  its  way  between  hair  and  hoof.  The 
sensibility  of  the  heel — seat  of  a  com — is  discovered  by  an  explo- 
ration with  the  blacksmith's  nippers.  Sometimes  it  is  made  known 
by  pressure  of  the  fingers,  the  cases  varying,  of  course,  according 
to  the  severity  of  the  disease.  There  is  often  heat,  especially  at 
the  coronet,  which  may  be  tumified,  particularly  so  when  the  corn 
is  of  a  compHcated  suppurative  character.  To  obtain  an  accurate 
view  of  the  disease  the  foot  should  be  well  pared,  and  this  opera- 
tion may  be  greatly  facilitated  by  the  application  of  povdtices  for 
twenty-four  or  forty-eight  hours  previously. 

It  is  only  by  the  objective  examination  and  the  pathological 
anatomy,  so  to  speak,  of  the  corn  that  the  moist  or  suppiu'ative 
variety  can  be  distinguished  from  the  dry,  and  we  shall  find  either 
a  simple  ecchymotic  spot,  or  a  complete  disintegration  of  tissues. 

rV.  Pathological  Anatomy. — The  lesions  vary  according  to 
the  severity  of  the  disease.  In  dry  corn,  we  find  an  infiltration 
of  blood  in  the  horny  structure.  This  is  blood  which  has  transu- 
dated  through  the  laminated  or  irritated  velvety  tissue  from  the 
injured  blood  vessels.  This  blood  gives  to  the  hoof  various  tints, 
more  or  less  pronounced,  not  unfrequently  yellowish,  according  to 
the  intensity  and  duration  of  the  disease.  The  hoof  sometimes 
loses  consistency  and  becomes  brittle ;  at  others,  it  is  hard  and 
dry,  and  then  resembles  healthy  hoof  minus  its  coloration.  If 
the  ecchymotic  spot  involves  the  whole  thickness  of  the  horn, 
from  its  surface  to  its  depth,  it  is  an  evidence  of  the  continued 
activity  of  the  cause.  A  deep  mark  indicates  a  recent  injury;  a 
superficial  one  is  an  evidence  of  an  older  corn,  which  disappears, 


612  OPEKATIONS    ON    THE    FOOT. 

and  then  it  seldom  produces  lameness.  Sometimes  the  marks  are 
arranged  in  layers,  the  healthy  horn  being  alternated  with  others 
which  are  infiltrated  with  blood.  This  is  a  proof  of  the  intermit- 
tent character  of  the  acting  cause  which  has  originally  produced 
the  corn.  The  ecchymosis,  however,  is  not  the  actual  seat  of  the 
corn,  which  is  more  in  the  velvety  and  especially  in  the  laminated 
tissues,  which  are  torn  or  bruised,  the  blood  escaping  thi-ough 
the  sole  simply  by  the  action  of  the  laws  of  gravitation.  It  is 
rarely  that  this  lesion  is  looked  for  in  the  case  of  dry  com,  and  it 
is  usually  ignored;  but  in  the  confirmed  corn,  a  true  alteration  of 
the  laminse  of  the  keraphyllous  tissue  is  observed.  This  is  re- 
placed by  a  horny  tumor,  a  kind  of  keraphyllocele,  analogous  to 
that  of  chronic  laminitis,  due  to  a  union  of  the  laminse  under  the 
influence  of  the  fibro-plastic  exudation  resulting  from  the  inflam- 
mation, which  is  of  varying  size,  and  presses  more  or  less  on  the 
sub-horny  tissues.  In  some  cases,  this  horn  breaks  up  little  by 
Uttle,  and  gives  rise  to  quarter  crack.  The  ecchymotic  spots  of 
the  dry  corn  may  vary  in  size  ;  they  may  range  from  the  size  of  a 
pea  to  that  of  a  ten-cent  coin.  At  other  times  they  may  occupy 
the  entire  space  between  the  bars  and  the  walls  of  the  foot. 

In  moist  corn,  there  is  not  only  hemorrhage,  but  also  inflam- 
mation proper,  with  serous  exudation.  The  hoof  is  colored,  as  in 
dry  corn,  of  a  brownish  tint,  due  to  the  infiltration  of  blood  which 
occm-ed  at  the  start ;  on  searching  deeper,  one  will  discover  be- 
tween the  hoof  and  the  living  tissues  beneath  a  separation  of 
varying  dimensions,  fiUed  by  citrine  serosity.  Most  frequently 
this  separation  takes  place  at  the  line  of  the  sole  with  the  wall, 
and  extends  under  both.  The  horny  svibstance  is  then  more  or 
less  impregnated  with  this  serosity,  and  then  has  a  charcteristic 
yellow  appearance  and  a  waxy  consistency. 

In  suppurative  corn,  or  more  properly,  suppurating,  the  in- 
flammation ends  in  sujjpuration.  The  pus  is  secreted  by  the  vel- 
vety and  laminated  tissues.  It  makes  room  for  itself  by  gradually 
separating  the  hoof  as  its  formation  progresses.  Before  long  it 
passes  between  the  podophyllous  grooves  of  the  bars  and  of  the 
quarters,  the  horny  are  lessened  from  the  fleshy  laminse,  and  in 
its  ascending  progress  the  pus  soon  makes  its  appearance  between 
haii-s  and  hoof  at  the  quarter,  at  the  heels,  or  at  the  glomes  of  the 
frog.  It  is  not  common  for  the  pus  to  make  its  way  through  a 
hoof  of  too  thick  or  resisting  a  nature,  unless  it  has  first  been 


DISEASES.  613 

siiificiently  softened  by  poultices  and  thinned  down  with  the  knife. 
This  suppuration,  in  the  generahty  of  cases,  brings  on  serious 
comphcatiou,  by  the  excessive  pressure  to  which  the  sub-horny 
tissues  are  then  subjected.  Gangrene  of  the  velvety  tissue  near 
the  branches  of  the  sole  and  of  the  podophyllous  grooves  which 
have  been  lacerated  in  the  suppuration,  are  very  common  comj)li- 
cations.  If  the  pus  remains  long  in  the  hoof  its  gangrenous  re- 
sults may  extend  to  the  os  pedis,  the  laternal  cartilage,  the  j)lantar 
cushion,  and  even  to  the  plantar  aponeurosis,  and  give  rise  to 
necrosis  or  caries  of  the  bones,  or  to  quittor,  to  a  more  or  less 
variable  extent.  This  sub-horny  suppuration,  which  may  some- 
times be  considerable,  as  well  as  the  compHcations  accompanying 
it,  are  detected  with  the  probe. 

V.  Termination  and  Prognosis. — Resolution  is  a  common 
termination  of  corns.  But  their  relapse  is  common  also,  especially 
in  feet  j)i'edisposed  to  them  by  bad  conformation.  A  kind  of 
chronic  condition  of  the  disease,  and  one  which  is  more  liable  to 
become  serious  than  the  accidental  variety,  is  the  ordinary  ter- 
mination in  this  case.  The  mere  extent  of  the  disease  is  of  less 
importance  in  the  diagnosis  than  the  predisposing  conditions. 
Generally  the  dry  corn  is  less  serious  than  the  moist  one,  and 
especially  less  than  the  suppurative.  CompHcated  corns,  princi- 
pally in  flat,  wide  feet,  with  low  heels,  by  reason  of  uncertain, 
j)rotracted  and  expensive  treatment,  are  in  general  fatal,  and 
necessitate  the  destruction  of  the  patient. 

VI.  Treatment. — The  largeness  of  the  sjjace  we  have  consumed 
in  considering  the  etiology  of  corns  will  compel  us  to  be  brief  in 
our  remarks  upon  the  preventhie  treatment.  Shoeing,  which  is  so 
often  the  cause  of  corns,  may  also  be  made  a  means  of  preventing 
them,  even  upon  predisposed  feet,  if  performed  with  intelligence 
and  proper  observation,  based  upon  the  anatomy  and  physiology 
of  the  foot.  Generally  speaking,  one  must  not  proceed  rashly  by 
changing  too  suddenly  the  mode  of  shoeing.  We  do  not  think 
that  any  one  specified  system  of  shoeing  will  with  certainty  pre- 
vent corns,  but  we  do  believe  that  each  case  demands  its  special 
study  and  care.  Usually,  a  flat  shoe,  and  which  has  the  heels 
rather  thin  but  resisting,  and  which  rests  on  the  wall  proper,  even 
of  the  diseased  one,  if  not  too  painful,  is  to  be  preferred.  If  the 
shoe  is  for  a  low-heeled  foot,  the  heels  of  the  shoe  should  be 
thicker  in  order  to  supply  their  insufficient  height  and  to  ojffer 


614  OPERATIONS    ON    THE    FOOT. 

more  resistance  to  the  weight  of  the  body.  Sometimes  the  pro- 
tecting effect  of  the  shoe  must  be  completed  by  the  use  of  a  plate 
of  gutta  percha  or  leather  between  the  foot  and  the  shoe ;  india  rub- 
ber does  not  answer,  as  by  its  elasticity  it  interferes  with  the  re- 
sistance of  the  shoe.  It  is  absolutely  necessary  to  preserve  the 
hoof  in  a  sufficiently  supple  condition,  to  effect  which  tar,  hoof 
ointments  and  other  greasy  substances  are  used.  Flaxseed  meal, 
poultices  of  cow  manure  and  salt  water,  a  damp  bedding,  tallow 
in  the  hollows  of  the  heels,  all  are  very  good  preventives  and 
even  curative  means,  which  a  careful  hostler  will  not  neglect. 
Paring  the  feet  thin,  as  practiced  by  some,  is  very  objectionable, 
and  is  a  serious  obstacle  to  the  extirj^ation  of  corns.  The  feet 
should  be  pared  as  little  as  possible,  especially  at  the  heels  or  in 
the  lacunae. 

As  for  the  curative  treatment,  there  are,  according  to  H.  Bou- 
ley,  four  indications  to  f oUow  :  Fkst,  remove  the  acting  cause ; 
second,  treat  the  injury  it  has  produced;  third,  relieve  the  pres- 
sure upon  the  diseased  region,  until  it  has  returned  to  its  healthy 
condition;  fourth,  prevent  the  return  of  the  injury. 

The  first  indication  is  easy  to  fulfill  w^ith  the  accidental  corn, 
but  often  nearly  impossible  in  that  due  to  a  bad  conformation  of 
the  feet.  The  second  indication  varies  according  to  the  extent  of 
the  disease.  Generally  it  is  advised  to  thin  down  the  hoof  at  the 
bruised  part  and  its  surroundings,  so  as  to  relieve  the  pressure  on 
congested  or  inflammed  parts.  Still,  we  are  not  in  favor  of  too 
much  thinning  of  the  hoof,  and  except  under  peculiar  conditions, 
would  practice  it  very  slightly.  Even  in  the  moist  corn,  we  be- 
lieve in  leaving  to  the  hoof  a  certain  protective  thickness.  The 
pressure  can  be  sensibly  diminished  by  the  apphcation  of  chloro- 
formedoil,  or  of  tincture  of  creosote ;  they  very  readily  penetrate 
the  hoof,  and  act  dkectly  upon  the  inflamed  parts.  We  believe 
that  excessive  paring,  the  "cutting  out  of  the  corns,"  to  use  the 
shoer's  expression,  is  injurious,  and  pi'edisposes  to  new  corns,  by 
weakening  the  region  and  promoting  a  more  rapid  desiccation  and 
contraction  of  the  hoof.  In  all  cases  of  dry  and  moist  corn,  one 
must  avoid  making  the  parts  bleed,  the  exposiu-e  of  the  soft  tis- 
sues, and  all  unnecessary  cutting.  Thinning  is  necessary  in  sup- 
purative corn,  and  has  to  be  done  over  the  whole  extent  of  the 
separation  of  the  horn,  and  a  wide  channel  of  exit  made  for  the 
pus  on  the  side  of  the  sole.     It  is  a  wise  plan  not  to  remove  the 


DISEASES.  615 

entire  mass  of  the  loosened  hoof,  as  by  this  the  dressing  will  be 
much  facihtated. 

Cold  baths  are  useful  in  aU  cases  of  corns  ;  at  other  times 
poultices  of  bran  or  other  material  are  preferred.  Sometime^ 
sulphate  of  ii'on  or  of  copjDer  are  added  to  the  bath,  especially  in 
the  moist  corn.  In  the  suppurative  kind,  when  the  suppuration 
is  m-egular,  and  when  complications  are  likely  to  follow,  warm  and 
slightly  aromatic  baths  are  better,  and  after  this,  a  dressing  with 
tincture  of  creosote,  renewed  the  same  day  or  the  next.  Later, 
cold  iron  or  copper  baths  may  be  used  again ;  if  the  suppui-ation 
has  broken  out  between  hairs  and  hoofs,  injections  of  Villates' 
solution,  after  free  escape  of  the  pus  by  the  plantar  surface,  are 
indicated. 

In  the  comphcated  suppurative  corn  these  means  are  insuffi- 
cient. We  must  cut  deeper,  and  for  this  the  animal  must  be 
thrown.  Then,  when  the  diseased  tissues  are  exposed  by  the 
removal  of  the  loosened  hoof,  the  nature  of  the  lesion  must  indi- 
cate the  requirements  of  the  treatment.  The  velvety  and  podo- 
phyUous  tissues,  if  gangrenous,  must  be  excised  as  far  as  their 
diseased  condition  extends;  carious  bone  is  to  be  scraped,  the 
fibrous  and  fibro-cartilaginous  structures,  if  necrosed,  are  to  be 
excised  or  cauterized,  or  sometimes  left  alone  and  watched,  ac- 
cording to  the  peculiar  character  and  extent  of  their  lesions  and 
the  extent  to  which  they  exist.  Once  operated  on,  a  dressing  with 
plates  and  bands  is  applied,  and  the  animal  allowed  to  rise. 

It  is  by  a  pecuhar  shoeing  that,  for  some  time,  the  painful  heel 
must  be  relieved  from  supporting  its  part  of  the  weight  of  the 
body,  and  protected  from  outside  pressure.  This  is  the  "bar 
shoe."  By  the  transverse  bar,  which  imites  both  branches,  it  pre- 
sents a  support  to  the  frog  and  protects  the  heels.  The  resting 
of  the  shoe  takes  place  equally  upon  the  wall  of  the  toe  and  of 
the  quarters,  especially  the  external,  and  it  does  not  rest  on  the 
diseased  heels  which  may  have  been  first  cut  away.  Some  veter- 
inarians prefer  the  truncated,  or  the  oblique  bar  shoe,  or  that  with 
a  bar  forming  an  acute  re-entering  angle.  Hartmann  recommends 
the  first ;  Mayer  prefers  the  bar  shoe  in  which  the  bar  heels  have 
been  thinned  down,  and  even  hollowed,  to  avoid  as  much  as  possi- 
ble the  pressure  on  the  diseased  part ;  this  shoe  has  sometimes 
given  us  good  results  in  horses  with  a  weak  frog.  In  many  cases 
ordinary  shoeing  answers  ;  then  the  diseased  hoof  is  pared  down. 


616  OPERATIONS    ON    THE    FOOT. 

The  branch  of  the  shoe  in  this  case  requires  a  greater  thickness. 
Whatever  may  be  the  mode  of  shoeing  used  much  advantage  can 
be  obtained  by  the  application  of  a  sole  of  leather  or  of  gutta 
percha. 

Sandckacks. 

Seime  of  the  French ;  Horyispalt  of  the  Germans ;  Fissura 
of  the  Italians — are  fissures  or  solutions  of  continuity  observed 
on  the  walls  of  the  foot,  ordinarily  very  narrow,  which  follow  the 
direction  of  the  horn.  Principally  observed  on  the  hoof  of  soh- 
peds,  it  has  been  seen  also  in  ruminants,  but  rarely,  and  of  httle 
importance. 

I.  Division. — They  may  exist  on  every  part  of  the  wall.  On 
the  median  line  of  the  nail  they  are  called  toe-crack,  and  then  are 
more  frequent  on  the  hind  feet.  They  are  rarely  found  on  the 
outside  or  inside  toe  (the  mamelles  of  the  French),  but  commonly 
met  with  on  the  quarter  {quarter-cracks),  then  situated  on  the 
lateral  parts  of  the  wall,  toward  the  heels,  and  more  frequently  on 
the  fore  feet,  especially  on  the  inside.  They  are  sometimes  oblique, 
relatively  to  the  thickness  of  the  wall.  Cracks  are  superficial  or 
deep,  according  to  the  thickness  of  the  wall  involved.  They  are 
complete  when  they  extend  from  the  coronary  band  down  to  the 
plantar  border  ;  incomplete  when  more  Hmited.  In  this  last  case, 
those  which  do  not  extend  u.j)  to  the  skin  are  the  more  disposed 
to  recovery,  and  will  grow  down  with  the  growth  of  the  wall, 
while  those  which  extend  to  the  coronary  band  are  more  serious, 
being  continually  aggravated  as  the  growth  of  the  hoof  progresses. 
According  to  the  date  of  their  formation,  they  are  called  recent 
and  old.  Simple  cracks  are  those  which  only  involve  the  wall ; 
they  are  coynpllcated  where  there  is  more  or  less  serious  lesion  of 
the  tissues  beneath,  such  as  inflammation  of  the  laminte,  hemor- 
rhage, or  caries  of  the  bone.  A  serious  compHcation  is  that  of 
keraphylocele. 

II.  Symptoms. — Often  the  solution  of  continuity  is  the  only 
one  obsei'ved,  and  it  is  the  special  characteristic  of  the  disease. 
But  the  fissure  may  be  masked,  either  accidentally  or  by  design. 
It  may  be  concealed  by  the  hairs,  by  the  mud,  or  covered  by  hoof- 
ointment,  tar,  wax,  or  even  a  putty  of  gutta-percha.  Concealed 
internal  cracks  have  sometimes  been  discovered,  such  as  fissures 
involviug  the  internal  face  of  the  wall,  which,  consequently,  were 


DISEASES.  617 

not  noticed  from  the  outside,  or  showing  but  a  slight  depression 
on  the  surface  of  the  wall.  These  cracks  are  only  discoverable 
when  the  foot  has  been  well  pared  down.  As  slight  as  the  solu- 
tion of  continuity  may  be,  it  participates  in  the  motion  of  dilata- 
tion of  the  foot,  and  it  is  better  detected  when  the  foot  is  raised 
than  when  it  rests  on  the  ground.  This  is  the  case  when  it  is  a  toe- 
crack,  but  on  the  contrary,  the  quarter-crack  is  more  open  when 
the  animal  rests  its  weight  on  the  leg,  in  which  case,  the  sepa- 
ration of  the  borders  of  the  cracks  may  be  from  two  to  four  milli- 
metres, and  may  expose  the  bottom  of  the  fissure.  Ordinarily, 
cracks  appear  first  at  the  coronet,  and  there  is  then  but  a  shght 
opening,  but  as  they  become  older,  and  grow  down,  they  have  a 
tendency  to  become  deeper  and  more  complete.  When  of  old 
standing,  their  borders  are  rough  and  scaly,  having  between  them 
an  ulcerated  tissue  and  sometimes  a  fungus  growth,  from  which 
escapes  a  sanious  fluid.  In  other  cases,  as  of  quarter-crack,  the 
edges  have  a  tendency  to  cover  each  other. 

Superficial  cracks  are  not  always  attended  with  lameness ;  it  is, 
on  the  contrary,  often  very  severe  when  they  are  deep.  The  pain 
is  generally  in  proportion  to  the  depth  and  degree  of  opening  of 
the  fissure,  and  also  esjDecially  to  any  comphcations  which  may 
exist  in  the  tissues  beneath.  The  lameness  seems  at  times  to  be 
due  to  the  injury  of  the  deep,  soft  tissues,  and  to  be  caused  by  the 
motions  of  the  horny  box  when  they  become  pinched,  irritated 
and  bruised.  The  afi'ected  animals  are  especially  lame  when  the 
foot  rests  on  the  ground,  and  the  lameness  is  greater  on  a  hard 
than  on  a  soft  surface.  If  an  animal  suffering  with  toe-cracks  is 
moved  on  descending  ground^  the  lameness  is  greater  than  on 
ascending  a  hill,  the  weight  of  the  toe  in  the  latter  case  producing 
less  ox^ening  of  the  edges  of  the  solution  of  continuity.  In  quarter- 
cracks,  the  severity  of  the  lameness  is  always  in  proportion  to  the 
rapidity  of  the  gait;  many  horses  which  are  but  slightly  lame  on 
a  jog,  become  much  more  so  when  the  gait  is  accelerated,  the  dila- 
tion of  the  heels  being  greater,  and  the  separation  of  the  b  rders 
of  the  crack  increasing  in  proportion  to  the  speed.  "When  there 
is  lameness,  there  is  naturally  an  increase  of  heat  and  sensibility 
of  the  foot,  especially  at  the  seat  of  the  crack.  This  is  often  dis- 
covered by  feeling  with  the  hand ;  old  cracks  are  generally  accom- 
panied by  a  thickening  existing  at  a  corresponding  point  of  the 
hoof.     A  deep,  but  recent  crack,  is  apt  to  be  accompanied  with 


618  OPERATIONS    ON    THE    FOOT. 

hemorrhage ;  there  is  blood  which  sometimes  exudes  between  the 
borders  of  the  crack,  and  flows  in  abundance  when  the  movement 
is  rapid ;  and  old  crack,  in  similar  circumstances,  may  show  pus, 
sometimes  mixed  with  blood.  A  misstep,  a  sprain,  may  give  rise 
to  hemorrhage  in  cracks  which  are  ordinai'ily  dry.  In  toe-crack, 
the  solution  generally  involves  the  thickness  of  the  wall,  through 
which  it  runs  in  a  line  almost  parallel  to  the  median  plane  of  the 
body,  while  in  quarter-crack  it  is  often  oblique  and  irregular,  not 
exactly  following  the  direction  of  the  fibres,  but  following  the 
thickness  of  the  wall  obliquely  in  such  a  way  that  the  external 
solution  of  continuity  is  more  posterior  than  the  external.  If  the 
crack  is  rather  old,  and  the  foot  where  it  exists  is  contracted,  it  is 
generally  incurvated,  one  border  covering  the  other,  and  some- 
times they  seem  to  be  moulded  on  each,  other,  so  as  to  cover  and 
conceal  the  true  crack. 

III.  Complications. — Among  these  we  may  first  mention  the 
inflammation  of  the  recticular  tissue,  which  is  first  pinched  and 
injui-ed.  This  may  be  followed  by  suppuration  and  local  gangrene. 
Very  often  the  disease  is  followed  by  necrosis  of  the  os  pedis,  and 
caries  of  varying  dejDth.  In  toe-crack  cases  have  been  seen  of 
caries  of  the  tendon  of  the  anterior  extensor  of  the  phalanges,  and 
even  arthritis,  though  rarely  occuring,  have  been  observed.  In 
quarter-crack,  one  may  have  cartilaginous  quittor  and  suppurative 
corns.  As  before  stated,  these  lesions  are  indicated  by  the  severity 
of  the  lameness,  the  presence  of  the  blood  or  pus  through  the  crack, 
and  the  extreme  sensibility  of  the  part.  It  is  especially  when,  in 
the  course  of  treatment,  a  part  of  the  hoof  has  been  removed,  that 
the  keratogenous  apparatus  has  been  exposed,  that  the  abnorma- 
coloration  of  the  podophyllous  tissue  is  seen,  in  its  swollen  condi- 
tion and  its  sensibility  to  pressui-e,  accompanied  with  the  presence 
of  the  pus  or  sanious  discharge,  and  at  times  the  necrosis  of  the 
bone.  Sometimes,  also,  foreign  substances,  as  dirt  or  gravel,  may 
be  found  introduced  in  the  cracks,  and  acting  as  causes  of  irrita- 
tion to  the  sensitive  tissues  below. 

A  complication,  not  so  frequent,  however,  according  to  some 
authors,  is  that  known  as  Keraphylocele,  and  which  consists  in  an 
hyj)ersecretion  of  horn,  from  the  coronary  band  on  the  inside  of 
the  crack.  Sometimes  the  horny  growth  remains  separate  from 
the  borders  of  the  crack,  and  is  adherent  to  the  wall  only  by  its 
base,  towards  the  coronary  band ;  this  is  especially  the  case  when 


DISEASES.  619 

tlie  wall  has  been  thinned  down  or  partly  removed.  In  other 
cases  it  is  adherent  to  the  two  borders  of  the  crack,  and  this  forms 
a  natural  cicatrix.  This  horny  column,  of  varying  length  and 
strength,  according  to  its  age,  presses  upon  the  tissues  beneath, 
and  gives  rise  to  severe  lameness.  With  time  there  is  correspond- 
ing atrophy  of  the  podophyllous  tissue,  or  even  of  the  os  pedis. 
This  is  often  followed  by  a  marked  deformity  of  the  hoof,  and 
especially  a  deep  fissure,  parallel  to  the  direction  of  the  crack. 
The  soft  tissues  under  the  keraphyllocele  often  in  time  become 
harder,  in  consequence  of  the  disappearance  of  the  papillae ;  the 
hoof  then  is  no  longer  adherent  to  the  tissues  beneath,  and  so 
incurable  cracks  are  the  result.  A  double  wall  or  false  quittor 
have  often  also  been  observed.  Thus  deformed,  the  foot  is  always 
subject  to  lameness,  even  if  the  crack  is  cured.  Contraction  or 
atrophy  of  the  frog  have  been  observed  with  quarter-crack. 

IV.  Progress,  duration,  termination. — Ordinarily,  cracks  once 
existing  become  worse.  From  being  superficial  and  imperfect 
they  become  deep  and  complete  as  a  natural  result  of  the  ordinary 
motions  of  the  foot.  If  rest  and  some  hygienic  attention  can  be 
given,  they  may  recover  spontaneously,  and  disappear  by  the  nat- 
ural downward  growth  of  the  hoof.  This  fortunate  termination, 
however,  is  principally  obtained  when  the  crack  is  due  to  acci- 
dental causes,  without  deformity  of  the  foot. 

V.  Prognosis. — Simple  cracks,  superficial  and  incomplete, 
especially  arising  from  the  plantar  border,  almost  always  recover 
under  rational  treatment,  which  has  for  its  principal  aim  the  pre- 
vention of  increase  in  the  size  of  the  fissure.  Cracks  starting  from 
the  coronary  band  are  always  of  a  more  serious  nature,  with  a  ten- 
dency to  increase  easily.  Still  they  are  no  longer  to  be  consid- 
ered incurable.  Cracks  in  which  the  borders  are  much  separated 
by  the  motion  of  walking ;  those  which  are  oblique ;  those  whose 
edges  are  incurvated  inward ;  those  where  a  poi-tion  of  the  wall, 
is  loose  ;  those  which  bleed,  and  those  where  there  is  a  continued 
irritation  of  the  sub-horny  tissues,  are  the  most  serious ;  and  so 
much  so,  that  they  may  require  quite  serious  surgical  interference, 
and  after  all  baffle  the  best  skill  of  the  operator. 

VI.  Etiology. — The  causes  of  cracks  vary  greatly,  and  are 
often  multiple  in  a  single  case.  Seldom  the  result  of  accident, 
they  are  most  commonly  the  combined  effect  of  both  a  predispos- 
ing and  an  extraneous  cause.     A  frequent  one  among  others  is 


620  OPEEATIONS    ON    THE    FOOT. 

the  relative  dryness  of  tlie  hoof,  which  then  becomes  excessively 
brittle.  We  have  seen  the  conditions  in  which  the  hoof  loses  its 
natural  flexibility,  and  shall  here  only  state  that  alternate  changes 
from  dampness  to  dryness  have  as  much  influence  as  the  drjTiess 
alone.  Cracks  are  more  frequent  in  animals  working  along  damp 
than  in  those  j^ulling  in  dry  and  stony  roads.  They  are  common 
in  animals  which  after  being  kept  in  pastures  are  placed  in  good 
paved  stables,  with  dry  bedding.  It  is  principally  in  these  condi- 
tions we  find  the  quarter-crack.  During  some  seasons,  while  a 
term  of  dryness  follows  continued  wet  weather,  the  conditions  are 
favorable  to  their  formation,  and  they  often  assume  an  epizootic 
form.  Emigration  to  dry  cUmates  is  a  frequent  cause,  by  produc- 
ing the  contraction  of  the  ungueal  structure.  This  last  cu'cum- 
stance  explains  why  cracks  are  more  common  in  army  horses, 
which  are  called  to  go  on  long  journeys  during  the  warm  days  of 
summer  But  if  the  European  horse  taken  to  Africa  suffers  less 
from  the  disease,  a  similar  result  occurs  to  the  African  horse  when 
brought  to  our  climate.  The  Arabian  horse  readily  contracts 
quarter-cracks  in  our  stables,  and  with  our  shoeing.  Animals  with 
small  feet,  or  with  hard  and  thick  hoofs,  have  a  natural  predispo- 
sition, which  is  also  found  in  Hungarian,  Kussian  or  Tartar  ani- 
mals. Feet  excessively  large  are  also  easily  affected  with  the 
disease,  esj)ecially  those  which  have  canker  or  grease. 

Unskilful  shoeing  may  predispose  to  cracks,  and  this  is  princi- 
l^ally  the  case  if  the  wall  is  thinned  or  rasped  down  too  much  ; 
the  same  result  is  obtained  from  shoes  which  are  too  wide  or  too 
heavy,  or  which  are  kept  on  by  too  heavy  nails. 

Feet  with  toes  turned  outward  are  predisposed  to  it,  as  in 
these  the  weight  of  the  body  rests  more  on  the  internal  quarter, 
which  being  thinner  than  the  external,  give  way  the  easiest.  Con- 
tracted feet  are  subject  to  it.  Quittor,  suppurative  corns,  and 
some  other  diseases,  are  also  predisposing  causes.  Among  occa- 
sional or  accidental  causes  may  be  mentioned  ti'aumatism,  contu- 
sions of  the  foot  and  blows  during  work.  The  service  of  heavy 
trucking  for  heavy  horses  exposes  the  hind  feet  to  toe-crack, 
especially  if  the  pulling  is  done  in  going  up  hill  or  on  slippery 
pavements;  mules'  feet  are  very  subject  to  it,  and  heavy  falls  in 
jumping  and  external  blows  are  occasional  causes. 

Heredity  in  cracks  has  been  mentioned.  We  do  not  admit 
this,  except  so  far  as  it  belongs  among  the  predisposing  causes 


DISEASES.  621 

which  may  be  transmitted,  and  we  should  object  to  an  animal  for 
breeding-  purposes  though  otherwise  well-formed,  if  he  were 
affected  with  cracked  feet. 

VII.  Treatment — Prophylaxy  ought  to  be  the  principal  treat- 
ment of  cracks.  It  is  not  always  easy,  however,  to  prevent  them, 
and  it  becomes  important  therefore,  to  treat  them  as  soon  as  they 
appear.  One  ought  at  least  to  try  to  prevent  them  from  becoming 
complete  and  deep.  This  form  of  treatment  may  bo  called  the 
hygienic,  as  it  is  not  properly  curative,  and  so  long  as  the  crack  is 
not  yet  completely  formed,  the  animal  may  be  kept  at  work  as  if 
everything  was  normal.  Curative  treatment  is  that  which  is 
apj)Hed  to  the  deep  or  complete  disease,  more  or  less  comj)licated, 
and  it  most  commonly  consists  in  removing  that  portion  of  the 
wall  which  bruises  and  irritates  the  tissues  beneath,  and  in  equal- 
izing the  wound.  In  general,  there  is  no  necessity  for  haste  in 
operating,  the  hygienic  treatment  being  often  sufficient  to  obviate 
the  need  of  serious  oj)erations.  The  distinction  between  the  hygienic 
and  curative  treatment  is  not,  however,  always  definitely  marked, 
and  quite  often  the  two  modes  of  treatment  must  be  combined, 
both  the  hygienic  and  the  curative  being  necessary. 

The  prophylactic  treatment  consists  specially  in  the  applica- 
tion of  tonics,  with  the  object  of  preventing  the  hoof  from  drying. 
Its  normal  hyrogoscopic  condition  must  be  preserved,  and  it  must 
be  prevented  from  taking  up  too  much  of  the  dampness  of  the 
ground  upon  which  it  travels,  as  well  as  from  losing  that  which 
keeps  up  its  flexibility.  At  times  it  must  be  rendered  more  moist 
and,  according  to  the  requirements  of  the  case,  recourse  must  be 
had  to  hoof  ointments  and  other  greasy  substances,  glycerine  and 
astringent  poultices.  At  the  same  time  the  shoeing  must  be  care- 
fidly  attended  to  ;  the  shoe  must  not  be  too  heavy  nor  too  wide, 
and  should  be  secured  by  nails  of  a  proper  size. 

The  hygienic  treatment  has  for  its  first  and  principal  indica- 
tions to  prevent  the  solution  of  continuity  from  increasing,  from 
extending  through  healthy  structure,  and  especially  to  new  hoof, 
as  this  is  secreted  by  the  coronary  band.  The  borders  of  the 
cracks  must  be  prevented  from  separating  in  the  movements  of 
dilatation  of  the  foot.  The  normal  suture  of  the  wall  not  being 
produced  by  the  natural  process,  or  at  least  producing  it  only  in 
keraphyUocele,  which  is  likely  to  be  as  injurious  as  the  crack  it- 
self, the  borders  of  the  crack  must  be  brought  together  artificially. 


622  OPERATIONS    ON    THE    FOOT. 

It  lias  been  supposed  that  this  could  be  done  with  the  putty  of 
Defay's,  a  mixture  of  gutta-percha  (2  parts)  and  gum  ammoniac 
(1  part),  introduced  into  the  well-cleaned  fissure,  and  pushed  in  as 
deeply  as  jiossible  by  a  warm  iron  plate  or  a  spatula.  This  putty 
is  excellent  for  superficial  cracks,  but  is  insufficient  to  bring  the 
borders  together  when  the  fissure  is  somewhat  deep,  or  especially 
if  it  is  irregular  and  sinuous. 

A  better  way,  at  least  for  toe  crack,  is  that  which  consists  in 
suturing  the  edges  of  the  solution  of  continuity  by  metallic  clasps, 
which  immobilize  the  hoof.  This  mode  is  always  preferable  to 
circular  liga*tures  of  wire  or  cord,  which  have  the  efi'ect  of  interfer- 
ing with  the  natural  elasticity  of  the  hoof.  Clasps  only  fix  the 
hoof  locally,  and  are  an  old  means  of  treatment,  having  been  used 
by  Sollej^sel  and  Garsault. 

It  was  advised  to  perforate  the  horn  through  and  through  with 
a  small  punch,  and  pass  a  wire,  which  was  bent  over  the  crack,  or 
twisted  together  at  the  ends.  The  same  authority  recommends 
the  dri\ing  of  a  nail  through  both  edges,  and  securing  it  tightly, 
as  in  the  application  of  the  nails  of  the  shoe.  This  treatment  was 
recently  recommended  by  Haupt,  Lafosse  and  Rey.  The  first  of 
these  professors  takes  an  ordinary  nail,  with  a  small  head,  drives 
it  through  one  edge  of  the  crack,  so  as  to  come  through  the  other 
at  an  equal  distance  from  the  point  of  entrance  ;  the  nail  being 
thus  driven  to  the  head  the  borders  of  the  crack  are  then  brought 
together,  and  the  nail  secured  in  the  ordinary  way.  Two  or  three 
of  these  clasps  are  employed,  according  to  the  extent  of  the  crack. 
Lafosse  makes  a  groove  on  each  side  of  the  fissure  about  one  centi- 
meter from  the  border,  in  a  direction  transverse  to  that  of  the 
fibres  of  the  wall,  which  limits  the  passage  of  the  nail.  The  nail 
is  then  introduced  and  secured  as  in  the  first  instance.  Eey 
makes  a  track  for  the  nail  first,  by  drilling  a  hole  through  the 
borders  of  the  crack.  The  animal  must  be  cast  diu'ing  these 
operations. 

The  best  kind  of  clasps  or  hooks  are  undoubtedly  those  of 
Vachette,  which  require  sj^ecial  instruments  for  their  application, 
but  give  a  real  solidity  to  the  means  of  fixing  the  position  of  the 
parts.  The  clasjDS  are  all  prepared,  made  of  strong  wire,  bent  at 
both  extremities,  and  slightly  sharp  inwardly  (Fig.  489).  These 
are  secured  on  the  foot  by  a  special  nipi^er  or  forceps  (Fig.  490) 
in  the  notches  made  on  the  wall  with  a  special  cautery  (Fig.  491) ; 


623 


this  cautery  has  its  extremities  flattened,  the  width  of  the  clasp, 
apart  from  each  other.  The  forceps  used  to  secure  these  is  strong ; 
its  branches  are  flattened  from  side  to  side,  and  grooved  inward, 
and  sufficiently  aj)art  from  each  other,  while  it  is  open,  to  receive 
the  clasps  between  its  border ;  these  branches,  with  the  clasp, 
are  exactly  fitted  to  the  notches  made  in  the  wall  with  the  cautery. 


FIG.  489.— Clasps. 


.V. 


Fig.  492.— Clasps  applied  in  the 
Thickness  of  the  Wall. 


Fig.  491— Cautery 
of  Vachette. 


Fig.  490.— Forceps  of  Vachette. 


It  is  sufficient  to  press  the  branches  of  the  forceps  to  close  the 
teeth  or  extremities  of  the  clasps,  and  bring  firmly  together  the 
borders  of  the  cracks.  The  number  of  clasps  varies  according  to 
the  case  under  treatment. 

A  very  simple  mode  of  effecting  reunion  of  the  borders  of  the 


Fig.  493.— Toe  Crack  secured 
with  Clasps. 


Fig.  494.— Quarter  Crack  secured 
with  Clasps. 


624  OPERATIONS    ON    THE    FOOT. 

crack  is  that  of  Hartmann.  It  consists  in  applying  upon  the  wall 
a  sheet  of  iron,  adapted  to  its  outside,  and  secured  on  the  foot  by 
two  small  screws. 

Clasps  are  of  a  certain  utility  for  toe  cracks,  but  they  often  fail 
in  quarter  cracks,  on  account  of  the  thin  condition  of  the  wall, 
which  is  particularly  well  marked  in  some  feet.  If  the  living  tis- 
sues are  encroached  upon,  the  clasp  may  give  rise  to  complica- 
tions, and  still  it  is  in  that  region  that  the  effect  of  the  motion  of 
the  hoof  must  be  prevented,  and  where  immobility  is  essential,  to 
prevent  the  separation  and  spread  of  the  edges  of  the  crack. 

Castandet  has  indicated  a  mode  of  treatment  which  has  proved 
very  successful,  and  which  may  be  applied  to  both  toe  and  quarter 
crack,  where  the  fissure  of  the  wall  extends  from  the  coronary  band 
to  the  lower  border  of  the  foot.  It  consists  in  making  a  groove 
at  about  one  centimeter  on  each  side  of  the  crack,  which  in  depth 
extends  to  its  bottom,  which,  when  reached,  is  white.  If  the 
solution  does  not  go  to  the  lower  border  of  the  foot,  these  grooves 
are  made  obliquely,  and  so  as  to  meet  together  at  their  lower 
termination,  and  form  a  V-shape.  Thus  the  crack  cannot  increase, 
and  it  grows  down  without  injury  to  the  soft  tissues.  Castandet, 
after  this  operation,  cauterizes  the  coronary  band. 

The  transversal  groove,  recommended  by  Levrat,  which  cuts 
the  tissues  in  two  and  extends  beyond  the  crack  on  each  side  about 
three  centimeters,  which  goes  down  to  the  soft  tissues  of  the  foot 
and  not  beyond  them,  has  for  its  object  to  diminish  the  e£fect  of 
percussion  produced  by  the  contact  of  the  foot  with  the  ground. 
It,  however,  does  not  prevent  the  edges  of  the  fissure  from  sepa- 
rating, as  the  groove  of  Castandet  does.  It  is  chiefly  useful  when 
there  is  a  separation  of  the  wall,  or  false  quarter.  At  times  a 
transverse  groove  has  been  made  to  prevent  an  incomplete  fissure, 
starting  from  the  plantar  border,  from  spreading  to  the  coronary 
band.  According  to  Hartmann,  a  single  hole  drilled  through  the 
wall  is,  in  most  cases,  sufficient. 

Shoeing  is  of  much  assistance  in  the  hygienic  treatment  of 
cracks.  In  toe  cracks,  the  toe  should  be  spared  as  much  as  pos- 
sible while  the  heels  are  lowered  by  paring,  or  by  the  application 
of  a  shoe  thicker  at  the  toe,  or  by  the  removal  of  the  calks  at  the 
heels.  While  Defays  holds  that  the  shoe  ought  to  lie  close  and 
tight  to  the  plantar  regions  of  the  crack,  Hartmann,  on  the  con- 
trary, advises  the  paring  of  that  surface  at  the  toe,  so  that  the  shoe 


DISEASES.  625 

cannot  rest  on  the  crack,  and  recommends  the  application  of  two 
clips  on  each  side  of  the  toe. 

In  quarter  cracks,  it  is  recommended  to  lower  the  toe,  to  save 
the  bars  and  the  frog ;  and  when  the  crack  is  incomplete,  and  not 
accomi^anied  with  lameness,  Defays  recommends  not  to  lower  the 
diseased  quarter,  and  to  have  the  heels  resting  well  on  that  branch 
of  the  shoe  which  shall  be  thick  and  straight.  Schreb'e  advises  a 
calk  on  that  side.  If  the  crack  is  deep,  with  excessive  lameness 
and  deep  lesions,  the  quarters  and  heels  must  be  joared  down  as 
much  as  possible,  and  a  bar  to  be  then  put  on,  resting  on  the 
frog,  if  need  be.  An  ordinary  shoe,  with  a  thick  branch,  may  be 
sometimes  emploj^ed. 

As  part  of  the  hygienic  treatment,  we  may  consider  the  means 
recommended  to  increase  the  secretion  of  the  coronary  band.  It 
is  known  that  a  slight  irritation  at  that  part  of  the  foot  is  accom- 
panied with  an  increased  secretion  of  hoof,  which  is  sometimes 
sufficient  to  give  rise  to  a  new  growth  of  healthy  horn.  One  of 
the  most  common  methods  is  to  slightly  cauterize  the  coronary 
band  with  the  iron.  This  was  already  known  by  old  practitioners, 
who  employed  an  S  cautery ;  but  they  committed  the  error  of 
biirning  the  hoof  too  deeply  instead  of  simply  cauterizing  the  cor- 
onary band.  SoUeysel  speaks  of  the  cauterization  of  the  band. 
Garsault  mentions  only  the  burning  with  three  S's  across  the 
crack.  Such  cauterization  could  have  no  useful  effect,  and  the 
deep  apj)hcation  of  the  cautery  might  be  followed  by  serious  com- 
plications. For  these  reasons  Lafosse  objected  to  them.  In  our 
days  it  is  abandoned,  and  the  coronary  band  only  is  touched  by  the 
cautery  ;  Castandet  and  Key  also  employ  it.  Chemical  cauteries 
have  also  been  recommended,  nitric  acid  by  Laguerriniere,  and 
more  recently  by  Lafosse. 

Putty  of  corrosive  sublimate  and  ointment  of  oxide  of  mercury 
are  also  in  use,  but  have  no  marked  advantages.  BHsters  prove 
very  beneficial,  and  also  turpentine,  as  recommended  by  Lafosse 
and  Key,  and  the  oil  of  Cade  by  Maury.  Defays  ad^dses  the  putty 
of  gutta  percha,  which  is  also  used  to  conceal  the  clasps. 

The  curative  treatment  is  necessary  w^henever  any  complication 
attends  the  crack.  If  it  is  recent,  antiphlogistics  and  rest  should 
be  first  tried ;  cold  bathing,  blisters  combined  with  hygienic  treat- 
ment may  then  be  sufficient.  A  single  groove  at  the  upper  part 
of  the  crack,  near  the   coronary  band,  is  often  sufficient,  or  a  re- 


626 


OPEEATIONS    ON    THE    FOOT. 


Pig.  495.— Operation  of  simple 
Toe  Crack  by  the  process  of  thin- 
ning down  the  wall  in  V-shape. 


moval  of  a  V-sliaped  portion  of  the  lioof, 
extending  more  or  less  deeply,  accord- 
ing to  the  condition  of  tlie  crack,  care 
being  observed  to  avoid  tlie  growth  of 
vascular  granulations  between  the  edges 
of  the  crack.  There  are  cases  where  it 
is  not  necessary  to  remove  the  segments 
of  the  hoof  entirely  down  to  the  soft  tis- 
sues, but  only  to  thin  them  down  and  to 
apply  over  it  a  dressing  of  oakum,  se- 
cured by  several  turns  of  roller  band- 
ages. In  all  cases  a  bar  shoe  must  be 
applied  to  relieve  the  pressure  on  the  quarter  where  the  crack 
exists.  This  is  principally  recommended  by  Prevost,  Gii"ard  and 
others. 

If  there  are  deep  lesions  of  the  sub-horny  tissues,  a  piece  of 
the  waU  must  be  removed,  and  the  operation  for  radical  cure  be 
performed.  It  is  an  old  operation,  by  which  all  diseased  tissues 
are  exposed.  As  little  of  hoof  as  possible  is  removed.  In  ojjerating, 
two  grooves  will  be  made  alongside  and  at  some  distance  from 
the  solution  of  continuity.  The  wall  between  is  removed  so  as  to 
exjoose  the  podophyllous  tissues  from  the  coronary  band  down  to 
the  sole,  care  being  taken  to  avoid  the  tearing  of  the  structure  of 
the  coronary  band,  and  the  diseased  tissues  are  then  removed.  If 
the  podophyllous  tissue,  it  is  excised  with  the  sage  knife  ;  if  the 
bone  is  carious,  it  is  scraped  with  the  drawing  knife.     The  whole 


Fig.  496.— Operation  for  Com- 
plicated Toe  Crack  B,  by  removal 
of  a  piece  of  the  toe  of  the  wall, 
yl  .4.— Oblique  grooves  limiting 
the  size  of  the  piece  to  remove. 


Fig.  497.— Dressing  for  Complicated  Toe  Crack. 


DISEASES.  G27 

is  then  dressed  vip  with  a  shoe  having  the  toe  thinned  down,  and 
extending  somewhat  beyond  the  border  of  the  foot. 

The  cicatrization  does  not  take  place  from  the  coronary  band 
alone,  but  also  from  the  horny  secretions  of  the  podophyllous  tis- 
sues. The  repair  is  then  quite  rapid.  The  first  dressing  is  re- 
moved after  eight  or  ten  days,  and  if  everything  goes  on  well  need 
not  be  changed  more  than  once  a  week. 

The  animal  is  not  to  be  put  to  work  until  the  hoof  has  obtained 
a  certain  consistency. 

The  operation  for  quarter  crack  is  similar,  except  that  only  one 
groove  is  I'equired  in  front  of  the  crack,  the  tissues  being  exposed 
as  in  the  operation  for  the  removal  of  the  lateral  cartilages  of  the 
foot. 

Calk. 

Synonyms. — Kronentritt  (Ger.) — Atteinte  (Fr.) — Thus  is  called 
a  contusion,  with  or  without  wound,  that  the  animal  receives  on 
the  coronet,  from  the  shoe  of  another  foot,  or  from  a  foreign 
body,  or  by  another  animal  walking  behind  or  alongside  him. 

The  skin  of  that  region  is  very  thick,  slightly  extensible,  not 
easily  yielding  to  the  imflammatory  swelling ;  there  is  commonly 
sloughing  and  mortification  of  tissues,  accompanied  with  violent 
pain.  It  is  frequent  in  animals  that  forge,  also  in  very  young 
horses  or  those  which  are  weak  in  the  lumbar  region,  and  which 
interfere  and  cut  themselves  in  walking.  This  lesion  is  also  very 
common  in  the  districts  where  horses  are  shod  with  high  calked 
shoes,  when  the  wound  resulting  from  it  is  made  by  the  internal 
branch  of  the  shoe,  which  lacerates  the  skin  of  the  coronet. 
Horses  shod  to  travel  on  ice  are  commonly  affected  with  it ;  the 
injury  being  more  or  less  serious  according  to  the  size  and  sharp 
condition  of  the  calk. 

Horses  ridden  in  ridding  schools  are  often  affected  with  it  dur- 
ing the  various  evolutions  of  the  haute  ^eole. 

It  is  called  single  when  the  wound  is  slight ;  concealed  when 
the  pain  is  great  and  continued,  as  in  the  case  where  it  takes  place 
on  the  tendon,  near  the  heels  or  the  quarters;  horny  when  the 
contusion  has  taken  place  on  the  wall  or  at  the  coronary  band ; 
complicated,  when  it  is  very  serious  and  accompanied  with  other 
more  severe  lesions.  It  is  always  a  horizontal  wound  or  a  tumor 
by  contusion. 


628  OPERATIONS    ON    THE    FOOT. 

I.  Symptoms. — It  is  ordinarily  recognized  by  the  wound  or 
swelling  which  exists  upon  the  parts.  Often  the  horse  is  lame, 
and  the  affected  part  warm  and  painful ;  sometimes  the  hairs  are 
cut,  the  skin  scratched  or  torn.  There  may  be  a  slight  bleeding 
at  the  seat  of  the  wound.  When  the  wall  has  received  the  con- 
tusion, the  vascular  network  underneath  may  become  inflammed, 
and  then  pus  is  formed  between  the  teguments  and  the  hoof, 
which  then  become  separated.  Sometimes  even  the  lateral  fibro- 
cartilage  of  the  foot  becomes  irritated  and  swollen,  and  ulcerates, 
especially  when  the  contusion  has  taken  place  on  that  part  where 
the  cartilage  is ;  in  this  case  the  injury  may  be  complicated  with 
cartilaginous  quittor. 

In  severe  cases,  one  may  i-ecognize  a  furuncular  calk,  charac- 
terized by  the  mortification  and  sloughing  of  a  portion  of  skin  at 
the  place  where  the  contusion  took  place  ;  it  is  the  cutaneous 
quittor  of  old  hippiatry,  with  formation  of  a  core ;  this  is  always 
very  painful,  and  the  inflammation  generally  spreads  underneath 
the  wall.  Bouley  calls  it  gangrenous  when  there  is  unlimited 
similar  mortification  of  the  tissues ;  in  this  case  the  slough  in- 
volves large  portions  of  the  skin.  At  times  it  may  be  called  phleg- 
'inonous,  when  an  abscess  forms  itself  under  the  skin,  then  the 
coronet  is  warm,  thick  and  inflamed,  and  the  pain  is  extreme. 
Then  if  an  incision  be  made  through  the  dermis  in  its  entire  thick- 
ness, an  abundant  bleeding  takes  place,  generally  followed  by  the 
resolution  of  the  disease ;  if  there  is  already  suppuration,  it  is  at 
the  same  time  immediately  allowed  to  escape. 

II.  Treatment. — If  the  injury  is  slight  or  recent,  whether  with 
or  without  wound,  very  cold  water  and  the  removal  of  the  cause 
by  taking  off  the  shoe,  are  sufficient  to  bring  on  a  cure.  But  if 
the  contusion  has  been  great  and  deep,  recovery  is  more  difficult 
to  obtain  on  account  of  the  suppuration  which  will  follow.  Then 
the  application  of  poultices  is  indicated  ;  if  there  is  formation  of 
a  core,  and  mortification  of  tissues,  poultices  of  honey  are  espec- 
ially indicated ;  in  case  of  phlegmon,  the  poultice  must  be  warm, 
and  then  incisions  and  counter  opening  must  be  made  for  the 
escape  of  f)us  ;  afterward  dressings  are  made  with  oakum  saturated 
with  tepid  wine  or  tincture  of  aloes. 

"When  the  caulking  is  horny,  the  use  of  emollient  topics  is  in- 
sufficient ;  an  excellent  way  then  is  to  obtain  the  required  sJough- 
ing  of  the  tissues  by  actual  cauterization — the  iron  heated  to  white 


DISEASES.  629 

heat ;  by  thus  destroyiag  a  portion  of  the  hoof  and  the  soft  tissues 
one  will  avoid  the  excessive  pressure  at  the  coronary  band ;  this 
may  also  be  prevented  by  the  thinning  down  of  the  wall  with  the 
sage  knife ;  but  one  must  be  careful  not  to  remove  too  soon  the 
portions  of  horn  which  may  be  detached. 

When  the  calking  takes  place  at  the  heel,  it  is  good — so  as  to 
prevent  other  complications — to  pare  the  foot  down,  especially  at 
the  heel,  to  remove  the  divided  hoof  and  transform  the  wound  to 
a  simple  one  which  can  be  dressed,  as  already  stated,  or  with 
digestive  ointment  secured  by  several  turns  of  a  roller. 

"WTien  there  are  wounds  of  the  teguments,  it  sometimes  hap- 
pens, if  the  immediate  union  has  not  been  obtained,  that  the  por- 
tion of  skin  forming  the  inferior  edge  of  the  wound  turns  down 
and  that  the  granulations  protmde,  tending  to  form  a  kind  of 
fungoid  growth.  Chabert  says  that  these  must  be  cut  off  and 
dressed  with  oakum  soaked  in  alcohol. 

Calking  at  the  hind  feet  being  the  most  severe,  and  those 
which  are  followed  by  the  most  serious  complications,  on  account 
of  the  urine  and  droppings  of  the  animal,  which  impregnate  the 
wound,  one  can  never  be  too  particular  in  keeping  them  clean  and 
dressing  them  well.  When  they  end  in  cartilagious  quittor,  they 
must  be  treated  as  that  disease  usually  is. 

As  to  the  means  of  prevention,  they  consist  in  not  placing  the 
horses  too  close  to  each  other  in  stables,  fairs,  etc.,  in  not  forcing 
them  too  much  in  their  gait,  in  shoeing  properly  those  which 
forge  or  interfere,  and  in  placing  or  riding  them  in  such  a  way  as 
to  avoid  the  possibility  of  then-  wounding  each  other. 

Punctured  Wound  of  the  Foot. 

Synonyms. — Naglebritt  (German) — Nail  in  the  foot  (English) — 
Clou  de  rue  (French). — In  veterinary  science  this  designation  has 
been  given  to  a  punctured  wound,  often  with  laceration,  some- 
times with  contusions,  either  at  the  sole  or  frog  of  the  foot  of  the 
monodactyles,  and  produced  by  sharp  or  cutting  bodies,  most 
commonly  nails,  upon  which  the  animal  steps.  The  form  of  these 
bodies,  the  direction  they  take,  the  force  with  which  they  pene- 
trate, and  the  part  of  the  sole  they  enter,  give  rise  to  various 
lesions  of  varying  gravity  as  they  are  older  or  as  the  injured  part 
enjoys  a  greater  sensibility. 

Etiology. — Nails,  stumps  of  nails,  are  most  often  those  which 


630  OPERATIONS    ON    THE    FOOT. 

are  picked  up  in  the  streets ;  at  other  times  it  is  a  metaUic  sub- 
stance elongated  and  sharpened ;  agaiu,  there  are  pieces  of  glass, 
or  other  substances,  such  as  bones  or  sharp  stones,  which  are 
picked  up  and  produce  the  wound. 

It  is  principally  in  the  streets  of  populous  cities,  in  the  yards 
of  builders,  or  on  the  grounds  where  buildings  are  pulled  down, 
that  horses  are  liable  to  receive  these  injuries.  In  rural  districts 
they  are  rare,  comparatively,  to  what  they  are  in  cities. 

It  is  evident  that  horses  with  wide,  flat,  thin,  softened  hoofs 
are  more  exposed  than  those  which  are  of  different  strvicture. 

I.  Divisions. — Punctured  wounds  of  the  foot  may  be  simple 
or  superficial,  deep  or  j^enetrating. 

One  of  these  bodies  j)iercing  into  the  frog  requires  to  go  in 
deep  to  be  serious,  as  above  the  frog  (which  is  itself  quite  thick, 
though  formed  by  a  soft  and  flexible  horn)  is  the  plantar  cushion, 
a  fibrous,  soft  and  elastic  mass,  which  offers  a  great  resistance. 
If,  however,  the  injuring  body  is  a  very  long  nail,  which  runs  per- 
pendicularly in  through  the  frog  at  the  plantar  cushion,  it  may 
reach  the  terminal  extremity  of  the  perforans  tendon,  situated 
immediately  under  the  plantar  cushion,  and  penetrate  the  sesa- 
moid sheath.  It  is  known  that  this  sheath  forms  a  sac  of  some 
dimensions,  that  it  extends  above  and  below  from  the  inferior 
half  of  the  coronary  to  the  semi-lunar  crest,  and  in  its  transverse 
axis  extends  from  one  retrosal  process  to  the  other ;  the  inferior 
portion  of  this  synovial  bursa  covers  the  plantar  aponeurosis  in 
its  whole  extent.  Sometimes,  again,  the  puncturing  body  pene- 
trates as  far  as  the  bone  ;  sometimes  the  navicular  ;  at  others  the 
OS  pedis,  and  sometimes  even  penetrates  into  the  articulation. 

II.  Symptoms. — They  vary  according  to  the  seat  of  the  lesion, 
its  depth,  the  mode  of  action  of  the  penetrating  body,  length  of 
time  it  has  remained  in  the  wound,  and  the  nature  of  the  lesions 
it  has  made  ;  all  conditions  which  may  change  the  character  of 
the  disease  from  a  first  degree,  when  the  animal  shows  no  evi- 
dence of  pain,  to  the  extreme  point,  where  its  life  is  in  danger, 
and  evens  ends  in  death,  by  the  excessive  local  alterations  and 
the  sufferings  accompanying  it. 

Often  the  first  point  which  assists  in  the  diagnosis  of  the  case 
is  the  history.  The  driver  has  seen  the  horse  become  suddenly 
lame,  has  examined  the  foot,  and  found  a  nail  more  or  less  deeply 
imbedded ;  or  it  is  the  surgeon  who  finds  the  nail  in  its  hiding- 


DISEASES.  631 

place.  The  exploration  of  the  part  shows  with  certainty  the  nature 
of  the  lesion,  the  direction  and  depth  of  the  wound,  as  well  as  the 
physical  condition  of  the  body  which  has  made  it,  and  all  circum- 
stances which  allow  a  positive  diagnosis  to  be  made. 

Quite  often  the  nail  is  no  longer  in  the  foot ;  sometimes  it  has 
left  its  mai'k — an  opening  which  can  be  explored ;  often  this  is 
not  visible  at  first  sight,  though  the  wound  may  be  even  deep  ; 
this  is  when  the  injury  to  the  hoof  has  been  very  slight,  and  when 
the  hoof  has  retracted  on  itself  by  its  elasticity  or  when  the  open- 
ing is  concealed  by  the  dirt  of  the  streets.  It  must  be  remem- 
bered that  sometimes  the  penetrating  body  remains  broken  in  the 
soft  tissues  after  its  entrance  through  the  hoof.  If  the  accident 
is  recent,  only  a  little  blood  may  be  found — Hquid  or  coagulated 
— over  the  wound ;  later,  some  serosity,  more  or  less  puinilent,  is 
observed ;  the  pus  is  white  or  black,  sometimes  mixed  with  syno- 
vial fluid  ;  sometimes  there  are  granulations  on  the  bodies  of  the 
wound  which  protrude  over  the  edges,  commonly  called  proud 
flesh.  Such  are  the  first  objective  symptoms  obtained  by  the 
exploration  of  the  parts.  Ordinarily  they  are  insufficient,  for  it 
is  not  always  easy  to  probe  the  wound.  It  then  becomes  neces- 
sary at  the  beginning  to  pare  off  the  hoof  all  around  the  wound, 
and  sometimes  to  hollow  it  at  the  point  of  injury,  without  going 
to  the  sensitive  structure,  however.  In  this  way  the  exploration 
and  the  probing  of  the  wound  are  rendered  much  easier. 

The  pain,  expressed  by  the  lameness,  is  almost  always  mani- 
fested ;  it  varies  according  to  the  seat  of  the  lesion  and  its  depth. 
At  first  the  intensity  of  the  lameness  does  not  give  the  exact 
measure  of  the  disease,  and  often  one  may  be  led  into  error  by  it; 
but  it  gives  an  exact  value  of  the  lesion  when  a  few  days  have 
elapsed  since  the  injury  was  received;  if  the  pains  are  slight  or 
absent,  they  indicate  that  the  reparative  process  is  going  on  well ; 
it  is,  on  the  contrary,  interfered  with  by  complications  when,  as 
time  goes  on,  the  lameness  increases  instead  of  becoming  dimin- 
ished. Generally  one  can  say  that  the  injury  will  amount  to 
nothing  when  the  lameness  is  slight,  while,  orl  the  contrary,  seri- 
ous complications  must  be  always  looked  for  when  it  is  great  and 
remains  on  long,  even  when  the  first  lesion  has  been  slight  and 
superficial.  The  wound,  w^hich  has  penetrated  through  the  hoof 
only,  has  no  symptoms,  no  sequeL-e  ;  the  animal  is  not  lame  from 
it,  or  if  he  be  the  lameness  is  very  shght,  the  foot  resting  entirely 


632  OPEEATIONS    ON    THE    FOOT. 

on  the  inferior  surface ;  when  the  resting  takes  place  only  on  the 
toe,  ordinarily  the  tendon  is  injured,  possibly  the  synovial  sheath; 
in  cases  where  high  inflammation  exists  the  pain  is  very  great,  the 
animal  walking  on  three  legs  only. 

The  anatomical  examination  of  the  injured  part  teaches  that 
the  most  serious  punctured  wound  of  the  foot  is  that  of  the  cen- 
tre of  the  foot,  where  the  tendon,  synovial  sac,  and  where  the 
articulations  may  have  been  injured.  Forward  of  this  the  wound 
is  less  serious,  even  if  it  involves  the  bone.  Posterior  to  it,  it 
can  only  injure  the  plantar  cushion.  Under  this  condition  the 
plantar  region  of  the  foot  is  divided  into  three  zones  ;  one,  ante- 
rior, from  the  toe  to  the  point  of  the  frog ;  one,  middle,  extending 
from  the  first  to  the  median  lacunse  of  the  frog ;  and  the  third, 
anterior,  covering  the  space  left  back  of  this  to  the  heels. 

The  most  serious  of  the  injuries  to  which  the  foot  is  liable  are 
those  caused  by  foreign  bodies  which  penetrate  the  middle  zone, 
that  being  the  most  complicated  portion  of  the  structure.  The 
symptoms  wiU  vary,  according  as  the  wound  extends  to  tlie  plan- 
tar apouevirosis,  or  only  as  far  as  this  membrane ;  or  lacerates  the 
soft  surrounding  tissues  without  touching  it ;  or  it  goes  beyond 
this  and  injuries  the  small  sesamoid  sheath,  or  even  going  deeper, 
severs  the  na\icvdar  bone,  or  its  ligamentous  attachment  to  the  os 
pedis  ;  or  reaches  the  last  phalangeal  articulation. 

A  wound  of  the  plantar  aponeurosis  is  always  very  painful, 
especially  when  complicated  with  necrosis,  in  which  case  there  is 
no  weight  put  on  the  diseased  leg,  and  continual  lancinating 
pains  and  reacting  fever  are  soon  observed.  The  wound  is  then 
fistulous  in  character,  and  the  suppuration  then  flowing  from  it 
meets  with  difficulties  in  its  escape,  which  gives  rise  to  a  state  of 
general  i  nflammation,  and  the  foot  becomes  hot  and  very  painful 
If  the  necrosed  scar  becomes  loose  and  sloughs  off,  being  de- 
tached by  suppuration,  improvement  soon  ensues,  but  as  the  ne- 
crosis of  the  tendon  has  generally  a  tendency  to  spread,  there  is 
an  increase  in  the  character  of  the  symptoms.  If  the  wound 
extends  to  the  sesamoid  sheath  from  the  start,  the  synovial  fluid 
is  observed  escaping,  first  pure,  but  soon  becoming  milky  and 
piu'ulent  in  aspect,  if  the  sheath  has  become  inflamed,  and  easily 
coagulated  in  yellowish  clots.  The  pain  is  then  very  great,  much 
more  so  than  when  the  aponeurosis  alone  is  diseased.  At  times, 
by  rapid  closing  of  the  plantar  wound  or  obstruction  of  the  fis- 


DISEASES.  633 

tula,  a  warm  swelling  forms  itself  in  the  back  of  the  coronet,  which 
raises  the  skin  by  degrees  and  becomes  elevated,  prominent  at 
one  point,  and  giving  a  feeling  of  fluctuation.  This  swelling  ends 
in  vdceration,  and  allows  the  escape  sometimes  of  an  abundant 
synovial,  purulent  discharge. 

The  wound  of  the  small  sesamoid  and  of  its  ligament  adds 
nothing  to  these  series  of  symptoms.  The  probing  of  the  tract 
will  only  determine  it  by  the  sensation  of  roughness  which  it  will 
give ;  but  generally  one  must  be  carefvd  in  using  the  probe,  es- 
pecially when  the  flow  of  synovia  is  absent.  If  the  foreign  body 
has  pierced  through  the  ligament,  or  has  penetrated  in  the  coffin 
joint,  phalangeal  arthritis  is  the  consequence.  The  same  result  is 
likely  to  follow  excessive  inflammation  of  the  foot  and  the  macer- 
ating effect  of  the  suppuration,  in  which  case  the  tendon  may 
soften  down  and  give  way.  It  may  then  also  hajjpen  that  this 
tendon  retracts  by  the  contraction  of  the  muscular  fibres,  and  can 
then  be  traced  U2:)ward  to  the  back  of  the  coronet,  or  of  the  fet- 
lock, according  as  the  giving  way  has  taken  place  higher  or  lower. 

"With  arthritis  there  is  a  hot,  painful  swelling  of  the  whole  cor- 
onet, with  diffused  oedema  above  the  fetlock  and  the  cannon,  and 
extending  upward  to  the  whole  leg,  complicating  the  lesion  by  lym- 
phangitis, and  painful  swelHng  of  the  lymphatic  glands.  Then  sub- 
cutaneous abscesses  are  found  round  the  coronet,  with  gangrene 
of  the  tissues ;  while,  again  there  may  be  only  an  extensive  fibro- 
plastic exudation,  which  ends  in  calcarious  organization  and  anchy- 
losis. 

In  the  anterior  zone  the  only  serious  lesion  met  with  is  caries 
of  the  OS  pedis,  characterized  by  great  pain,  continual  lancination, 
loss  of  the  use  of  the  leg,  and  high  reacting  fever.  There  is 
abundant  bloody  and  foetid  suppuration,  and  the  probe  gives  the 
sensation  of  the  soft  resistance  of  the  bone,  of  its  rough  condition, 
and  its  partial  fragility.  The  caries  having  most  generally  a  pro- 
gressive march,  complications  of  separation  of  the  hoof,  to  a  vary- 
ing extent,  are  often  seen ;  the  pus  arrives  at  the  surface  between 
hairs  and  hoof ;  and  diflused  gangrenes  are  also  often  seen,  which 
extend  as  well  to  the  podophyllous  as  to  the  velvety  tissues. 

In  the  posterior  zone,  the  only  serious  wounds  are  the  lateral 
ones,  which  may  injure  the  fibro-cartilage  and  become  comj)licated 
with  their  caries  or  quittor  and  fistula  down  to  the  lacunae  of  the 
frog,  as  we  have  seen  in  sujopurating  corn. 


634  OPERATIONS    ON    THE    FOOT. 

Nails  may  penetrate  the  joosterior  zone  through  and  through,, 
coming  out  behind  the  coronet,  withovit  danger.  The  sub-horny 
suppuration  may  detach  the  frog  and  be  the  only  serious  compli- 
cation to  be  met  with. 

As  terminations  of  all  these  injuries  we  may  see  resolution,  sup- 
puration, gangrene,  softening  of  the  tendons  and  phalangeal  arth- 
ritis, and  as  sequelae,  bony  tumors  of  the  coronet,  and  anchylosis. 
The  most  serious  complications  are  the  dropi^ing  of  the  entire 
hoof,  the  rupture  of  the  tendons,  tendinous  and  cartilaginous  quit- 
tors,  for  the  injured  hoof,  and  chronic  laminitis  for  the  opj)Osite 
one. 

IV.  JPrognosis. — This  varies  according  to  the  seat  of  the 
wound.  Less  serious  in  the  posterior  than  in  the  anterior  zone, 
it  is  less  in  the  last  than  in  the  middle,  where  the  region  is  so 
comphcated  and  the  nature  of  the  tissues  so  different.  The  dej^th 
of  the  wound  has  also  some  influence  on  the  prognosis.  Wounds 
of  the  plantar  aponeurosis  are  more  dangerous  than  those  of  the 
plantar  cushion ;  those  of  the  sesamoid  sheath  are  more  so  than 
those  of  the  aponeurosis ;  they  are  still  more  serious  if  the  bones 
are  affected ;  the  worst  of  all  is  that  of  the  joint.  The  direction 
of  the  foreign  body  and  its  simple  or  complicated  action,  will  also 
influence  the  prognosis. 

This,  we  have  already  said,  can  be  established  by  the  severity 
of  the  lameness.  The  nature  of  the  foreign  body  must  also  be 
taken  into  consideration ;  if  blunt,  which  crushes  the  tissues,  it  is 
more  dangerous  than  if  sharp  and  jjointed.  In  a  flat  or  convex 
foot,  punctured  wounds  are  more  serious  than  in  a  well-made  foot. 
They  are  less  serious  in  heavy  than  in  light  draught  horses,  as  the 
former,  though  they  may  remain  lame,  are  still  useful.  The 
excitable  condition  of  a  patient  will  also  alter  the  prognosis. 
Wounds  of  the  anterior  feet  are  more  serious  than  those  of  the 
posterior. 

V.  Treatment. — In  all  cases,  the  first  indication  is  to  obtain  a 
natural  cicatrization  and  natural  repair,  always  more  rapid  and 
perfect  than  that  which  is  gained  by  surgical  interference.  This 
is  generally  easily  secured,  and  for  this  reason  it  is  important  to 
avoid  too  severe  manij)ulation  upon  the  injured  foot.  One  must 
watch  the  progress  of  the  disease,  give  the  foot  as  much  rest  as 
possible,  remove  the  shoe,  thin  down  in  its  whole  extent  the  plan- 
tar hoof,  so  as  to  avoid  any  pressure,  and  keep  the  foot  in  a  cool- 


DISEASES.  635 

mg  bath — ordinary  cold  water,  to  which  often  is  added  acetate  of 
lead,  sulphate  of  iron,  or  common  salt,  very  beneficially.  Poultices, 
cold  preferable  to  hot,  give  excellent  results.  By  this  treatment, 
the  progress  of  the  inflammation  is  checked,  and  very  often  deep  and 
serious  wounds,  even  those  where  the  tendinous  sheath  has  been 
injured,  are  easily  cured.  If  the  lameness  gradually  diminishes, 
the  case  rapidly  gets  well ;  at  any  rate,  by  this  treatment,  the  inflam- 
matory process  is  diminished,  and  the  painful  pressure  of  the  hard- 
ened and  thick  hoof  is  avoided. 

In  the  winter,  when  cold  baths  are  of  difficult  application, 
chloroformed  or  carbolized  compresses  may  be  applied  round  the 
foot.  The  hoof  is  thus  softened  and  the  pain  reduced.  At  other 
times  a  blister  is  aj)plied  round  the  coronet. 

If  the  lameness  remains,  or  seems  to  increase,  it  is  due  to  ten- 
dinous necrosis  or  caries,  and  it  becomes  necessary  to  operate. 
Must  the  surgeon  then  have  recourse  to  an  operation,  and  make  a 
simple  wound  with  his  sharp  instrument  ?  Or,  is  it  still  better  to 
merely  depend  on  natural  resources,  and  assist  them  ? 

It  is  difficult  to  lay  down  any  special  rules.  If  the  disease  is 
old,  if  the  necrosis  has  progressed  and  is.  still  increasing,  a  serious 
'operation  becomes  necessary.  If  the  necrosis  is  recent,  one  must 
be  guided  by  external  indications.  Notwithstanding  (Renault 
remarks)  one  should  not  be  too  hasty,  as  the  animal  must  neces- 
sarily be  laid  up  for  several  months  afterward.  It  is  often  suffi- 
cient, in  a  recently  punctured  wound,  in  order  to  avoid  complica- 
tions, to  modify  the  conditions  of  the  fibrous  tissues  in  the  whole 
extent  of  the  lesion,  by  applying  substances  simply  antiseptic,  or 
still  better,  slightly  caustic.  Rey  employs  the  cold  bath,  in  which 
he  dissolves  a  pound  of  sulphate  of  coj)per  for  ten  or  fifteen 
quarts  of  water ;  by  this  means  he  has  secured  the  speedy  recovery 
of  severe  punctiu-ed  wounds.  For  a  long  time,  and  with  the  same 
object,  we  have  been  using  a  mixture  of  equal  j)arts  of  sulphate 
of  coj)per  and  sulphate  of  u'on,  having  first  hollowed  the  foot 
downward  around  the  source  of  the  puncture,  and  the  sole  being 
pared  down  as  thin  as  could  be  borne. 

H.  Bouley  prefers  the  application  of  pulverized  corrosive  sub- 
limate ;  after  tracing  the  wound  to  its  bottom,  he  fills  it  well  with 
the  powder.  This  remedy  was  already  recommended  by  Solleysel, 
who  used  it  in  caries  of  the  os  pedis.  Other  practitioners  prefer 
phenic  acid,  and  claim  for  it  great  advantages.     By  the  action  of 


OPERATIONS    ON    THE    FOOT. 


the  caustics  upon  the  fibrous  tissues  exposed  to  necrosis,  or 
ab-eady  in  that  condition,  a  double  salutary  result  is  obtained ; 
first,  the  transformation  of  the  part,  which  is  the  seat  of  a  pro- 
gressive gangrene,  into  a  chemical  eschar ;  and,  again,  promoting 
the  more  active  vascularization  of  the  surrounding  parts,  and  con- 
sequently their  increased  power  of  healthy  reaction ;  conditions 
twice  favorable  to  the  sloughiug  of  the  eschar,  and  the  process  of 
repair  following  it. 

When  the  wound  has  reached  the  os  pedis,  and  this  has  become 
carious,  a  portion  of  the  sole  is  removed,  so  that  the  supj)uration 
can  escape,  the  bone  is  scraped  off,  and  a  dressing  of  carbolized 
alcohol  applied,  kej)t  on  by  a  thin  shoe  or  slij)per,  with  tin  plates. 

When  there  is  a  fistulous  wound,  through  which  syno'sia  escapes, 
yet  not  purulent,  caustics  are  recommended.  Solleysel  preferred 
these,  but  blacksmiths  used  them  so  carelessly  that  they  soon 
were  discarded.  Since,  however,  they  have  been  employed  again, 
not  in  powder,  but  as  trochiscus.  Eey  recommends  the  corrosive 
sublimate  in  conic  pencils,  introduced  to  the  bottom  of  the  fis- 
tula ;  by  them  he  obtains  an  eschar,  a  solid  clot,  from  the  synovia, 
which  closes  up  the  wound  and  prevents  the  synovial  flow,  at  the 
same  time  stimulating  the  granulations  which  close  up  the  fistula. 

We  have  ah-eady  said  that  these  measures  must  be  used  only 
when  the  sjTiovia  is  not  pm'ulent,  as  then  the  escape  of  morbid 
Hquids  may  be  prevented.  It  is  not  then  uncommon  to  see 
abscesses  forming  at  the  back  of  the  coronet ;  generally  not  so 
serious  as  is  usually  believed ;  not  as  much  as  those  which  take 
place  in  front  and  which  are  due  to  suppuration  of  the  articula- 
tion. After  the  running  out  of  those  abscesses,  sometimes  the 
wound  of  the  foot  assumes  a  better  aspect,  the  symptoms  im- 
prove, and  the  animal  recovers  rapidly.  Injections  of  a  very  weak 
solution  of  tincture  of  iodine,  as  well  as  the  baths  of  copper  or 
iron,  are  then  very  advantageous.  Hertwig  advises  the  introduc- 
tion of  a  seton  through  the  sesamoid  sheath. 

This  treatment  is  not  always  sufficient,  especially  where  the 
lesions  are  deep.  All  the  diseased  structures  must  be  then  ex- 
posed, and  they  must  be  removed  and  the  wound  changed  into  a 
simple  one,  which,  well  di-essed,  will  heal  without  difficulty.  The 
operation  is  required  in  proportion  to  the  extent  and  nature  of 
the  lesion,  and  if  this  is  recent  and  comparatively  superficial,  if  a 
piece  of  the  foreign  body  yet  remains  in  the  woimd,  or  if  its  re- 


DISEASES.  637 

moval  has  resulted  in  the  sloughing  of  a  small  piece  of  dead  tis- 
sue, it  may  be  sufficient,  the  foot  being  pared  thin,  as  already  ad- 
vised, to  simply  make  an  infundibuliform  opening,  various  in  size, 
so  as  to  exjDose  the  bottom  of  the  wound.  For  that  pm-j)ose,  the 
drawing  knife  or  the  sage  knife  is  used,  a  hght  shoe  is  put  on,  and 
a  dressing  of  digestive  ointment,  segyjDtiacum,  or  simply  alcoholic 
mixtures,  are  kept  on  by  plates.  At  times  it  is  advantageous  to 
assist  the  process  of  sloughing  by  the  use  of  caustics,  sulphate  of 
copper,  Villate's  solution,  tincture  of  iodine,  etc.  If  the  wound  is 
near  or  at  the  heels,  the  branches  of  the  shoe  are  shortened  and 
an  appropriate  dressing  is  put  on.  Subsequent  dressings  require 
the  same  care.  Cicatrization  goes  on  and  the  hoof  soon  returns 
to  its  normal  condition.  Sometimes  the  surgeon  is  called  only 
when  the  inflammation  is  far  advanced  and  suppuration  already 
established.  This  peculiar  condition  is  manifested  by  the  swell- 
ing and  heat  of  the  parts,  the  acute  pains,  and  often  the  high  fever. 
The  wound  then  must  be  at  once  enlarged  and  the  pus  allowed  to 
escape,  and  this  is  the  true  operation  for  deep  punctured  wounds. 

The  operation  becomes  more  serious  if  there  is  separation, 
partial  or  total,  of  the  sole  or  frog,  with  a  more  or  less  advanced 
disorganization  of  the  tissues  underneath.  If  there  is  escape  of 
purulent  synovia,  extensive  cuttings  are  to  be  made. 

In  olden  times,  to  perform  the  operation  of  the  deep  punc- 
tured wound,  the  entire  removal  of  the  sole  was  performed,  with- 
out distinction  or  exception  and  notwithstanding  the  severe  pain 
following  it.  In  our  day,  a  portion  of  separated  sole  or  frog 
only  is  taken  off.  This  is  done  by  slices,  and  only  so  far  as  neces- 
sary for  the  other  steps  of  the-  operation. 

This  operation  is  indicated  when  there  is  great  pain,  continu- 
ing without  regard  to  what  treatment  has  been  followed.  It  is 
also  when  the  plantar  aponeurosis  has  assumed  a  greenish  tint, 
diffused  in  its  extent,  without  indication  of  a  repairing  process, 
with  the  marks  of  sloughing  of  the  dead  structure.  The  instru- 
ments needed  are  various :  sage  knives,  single  and  double ;  draw- 
ing knives  of  various  sizes :  a  directory,  bistoury  and  forceps. 

The  animal,  properly  secured,  and  placed  under  ansesthetics, 
if  too  irritable  (Bouley),  the  horny  structures  are  removed  where- 
ever  the  suppuration  has  separated  them  from  the  soft  tissues  be- 
neath, or  the  sole  is  only  pared  down  thin,  as  well  as  the  horny 
frog  in  its  whole  extent. 


638  OPERATIONS    ON    THE    FOOT. 

This  first  step  of  tlie  operation  completed,  the  operator  intro- 
duces a  director  into  the  whole  tract  of  the  fistula,  and  with  a 
sharp  sage  knife  a  longitudinal  incision  is  made,  following  the 
canula  of  the  directory  as  a  guide,  above  and  below  the  fistulous 
opening,  and  in  the  direction  of  the  antero-posterior  axis  of  the 
foot.  This  done,  with  the  sage  knife  held  in  full  hand,  with  one 
cut  the  surgeon,  by  a  deep  incision,  removes  the  greatest  thick- 
ness of  the  tissues  all  around  the  longitudinal  cut  he  has  just 
made,  transforming  the  fistulous  tract  into  a  conical  infundibu- 
lum,  whose  apex  is  at  the  bottom  of  the  wound.  If  then  the  apo- 
neurosis is  not  yet  exposed,  the  operator  removes  with  the  for- 
cej^s  and  bistoury  whatever  tissues  still  cover  it. 

Then  follows  the  excision  of  the  aponeurosis.  This  is  meas- 
ured by  the  extent  of  the  necrosis.  As  a  rule,  it  must  reach  a 
little  beyond  the  diseased  part,  and  by  that  operation  the  puru- 
lent synovia  finds  a  free  chance  to  escape. 

If  the  sesamoid  is  sound,  it  must  be  left  alone,  but  if  the 
diathrodial  surface  is  roughened,  ulcerated  and  on  the  way  to 
desquammation,  it  must  be  scraped  off  with  the  narrow  and  long 
drawing  knife. 

The  complications  of  arthritis  cannot  be  interfered  with  by  the 
surgeon.  It  is  by  general  antiphlogistic  treatment,  and  by  local 
and  external  api^lications  that  they  must  be  treated. 

The  operation  ended,  the  dressing  follows,  and  becomes  one 
of  the  most  important  parts  of  the  means  of  recovery.  As  light  a 
shoe  as  possible  is  placed  on  the  foot,  a  coat  of  hoof  ointment, 
Venice  turjoentine,  or  tar,  is  applied  upon  the  thinned  sole  ;  j^ads 
of  oakum,  wet  with  alcohol,  carbolized  or  not,  are  then  carefully 
laid  on  the  soft  jDarts. 

Some  practitioners  cover  them  with  cegyptiacum  (Mandel) ; 
others  simply  with  Venice  turpentine  (Lafosse). 

The  pads  or  balls  of  oakum  must  not  be  too  thick  or  hard,  as 
no  pressure  is  needed.  The  whole  dressing  is  retained  by  plates, 
and  several  circular  straps  of  tape  above  the  coronary  band.  Cold 
water  baths  are  always  good  afterward. 

In  the  subsequent  dressings  one  must  bear  in  mind  that  the 
work  of  repair,  the  granulating,  is  more  rapid  in  the  tissues  of  the 
plantar  cushion  and  fleshy  sole  than  upon  the  bone  and  tendinous 
tissue  ;  and  that  in  this  case  it  is  longer  than  upon  bone  if  this 
has  been  scraped.     The  result  of  this  is  a  wound  which  presents 


DISEASES.  639 

various  aspects  in  its  progress  of  cicatrization.  It  often  has  a 
handsome  granulating  appearance  over  its  entire  surface,  while  at 
the  bottom  there  may  be  a  clot  of  coagulated  synovia  covering  the 
surface  of  the  sesamoid  and  the  edges  of  the  wound  of  the  plantar 
aj^oneurosis.  A  free  escape  of  synovia  must  always  be  facilitated, 
and  often  the  development  of  the  granulations  has  to  be  con- 
trolled. If  the  cicatrization  proceeds  weU  and  regiilarly,  dress- 
ings need  be  changed  but  seldom,  being  satisfied  with  the  cold 
bath,  with  copper  solutions. 

Dressings  can  be  made  with  tincture  of  myrrh  or  aloes  ;  some- 
times in  the  centre  with  tincture  of  iodine.  At  times  caustics  are 
again  used,  while  at  others,  fragments  of  bone  or  of  tendon  have 
to  be  excised. 

The  entu'e  closing  of  such  a  woiind  may  sometimes  take  place 
in  a  month ;  but  often,  even  without  comj^lications,  two  or  three 
are  required.  Complications  may  easily  make  their  appearance  and 
interfere  with  the  cicatrization.  Sometimes  j)ieces  of  necrosed  tis- 
sues which  remain  at  the  bottom  of  the  wound  give  rise  to  fistulous 
tracts,  until  they  are  entirely  removed.  In  this  case,  twice  as  long 
a  time  may  be  necessary  to  a  cure.  The  pain  and  intensity  of  the 
lameness  after  the  operation  do  not  accurately  indicate  the  nature 
of  the  disease ;  the  general  phlogosis,  especially  the  synovial  in- 
flammation, always  causes  a  special  acute  pain,  which  for  from 
three  to  six  weeks  may  prevent  the  animal  from  resting  his  foot 
on  the  ground.  This  pain  is  entirely  indej^endent  of  the  process 
of  repau-,  and  must  not  alarm  the  veterinarian.  "While  the  react- 
ing fever  is  absent,  and  there  is  a  good  appetite  and  no  swelling 
in  the  region  of  the  coronet,  the  progress  may  be  considered  sat- 
isfactory. 

After  the  cicatrization  of  the  plantar  wound  made  during  the 
operation,  the  parts  may  return  to  their  physiological  condition, 
or  nearly  so ;  or,  on  the  contrary,  remain  in  an  entirely  abnormal 
condition.  Often,  indeed,  the  sesamoid  sheath  may  become  obht- 
ei'ated,  the  diarthrodial  surface  has  lost  its  smoothness  and  there  is 
no  more  sliding  upon  it,  the  tendon  having  become  united  to  it.  The 
animal  then  remains  lame,  and  cannot  be  utilized  except  in  walk- 
ing ;  if  coronary  anchylosis,  ringbones  are  detected,  and  the  appli- 
cation of  firing  is  indicated.  Sometimes  neurotomy  gives  excellent 
results. 


640  OPERATIONS    ON    THE    FOOT. 

CONTKACTED    HeELS HoOF    BoUND. 

Synonym:  ZwangJuiff,  German;  Encdsleture,  French;  Incas- 
tellatura,  Italian;  Encatenadura,  Spanish. 

This  name  has  been  given  to  a  defect  of  the  horse's  foot,  by 
which  it  becomes  characterized  by  its  general  narrowness,  more 
marked,  however,  in  the  posterior  than  the  anterior  part.  It  is 
especially  marked  by  the  diminution  of  the  lateral  diameter  of  the 
horny  box,  the  deformity  consisting  in  a  greater  or  less  contrac- 
tion of  the  heels  and  of  the  quarters. 

It  is  principally  observed  in  the  fore  feet,  and  it  is  there  only 
that  it  presents  the  characters  we  are  about  to  describe.  This  is 
due  to  the  fact  that  in  the  fore  legs  there  is  need  of  a  certain  ex- 
pansibility in  the  posterior  part  of  the  foot,  which,  especially  during 
the  action  of  locomotion,  receives  the  weight  of  the  body ;  while 
the  contraction  of  the  hiad  feet  gives  rise  only  to  an  ordinary  form 
of  lameness.  Sometimes  one  of  the  anterior  legs  only  is  affected; 
sometimes  both,  and  ia  this  latter  case  the  alteration  is  usually 
greater  in  one  foot  than  in  the  other. 

Some  horses  are  also  seen  whose  feet  are  contracted  only  on 
one,  usually  the  inner  side,  while  the  other  preserves  its  normal 
form  and  dh^ections. 

Sometimes  "hoof-bound"  is  only  a  simple  deformity,  without 
lameness  and  without  serious  result.  But  in  most  cases,  it  consti- 
tutes a  very  serious  affection,  which  renders  many  horses  useless 
and  almost  without  value.  It  is  of  more  common  occurrence  than 
is  generally  admitted,  and  gives  rise  to  many  other  affections  of 
the  foot.  Cases  of  lameness  treated  as  located  in  the  shoulder,  or 
as  navicular  disease,  are  very  often  nothiag  but  the  result  of  com- 
mencing contraction  of  the  heels.  True  navicular  arthritis  and 
hoof-bound  are  closely  related.  "Whether  the  disease  of  the  sesa- 
moid sheath,  arising  primitively,  brings  on  the  subsequent  con- 
traction; whether  the  contraction  already  existing  gives  rise  to  the 
alteration  of  structm-e  which  constitutes  the  disease  so  named, 
cannot  always  be  determined.  Hoof -bound  was  known  in  old 
times,  and  the  oldest  hippiatrics  have  proposed  means  to  cure  it. 
Eiders  especially  have  studied  it,  because  the  disease  is  most  com- 
mon in  fine  saddle  horses,  whose  feet  are  small.  It  is  fi-equent  in 
Turkish  and  Spanish  horses,  and  animals  from  the  Pyrenean  dis- 
tricts, but  common  horses  are  not  exempt  from  it. 


DISEASES.  641 

n.  Bouley  describes  two  forms  of  the  disease,  the  true  and  the 
pretended  or  false  contraction.  In  the  first,  the  hoof  is  very  nar- 
row, sometimes  even  concave  on  its  lateral  face,  to  such  an  extent 
that  its  antero-posterior  considerably  exceeds  its  tranverse  diame- 
ter; while  at  the  same  time  its  wall  is  more  vertical,  and  the  heels 
considerably  higher  than  normal,  and  the  foot  looks  like  that  of  a 
mule,  of  which  this  is  recognized  as  the  normal  appearance.  In 
the  false  contraction,  there  is  merely  a  diminution  of  the  transver- 
sal diameter  of  the  homy  box  in  its  posterior  parts,  the  foot  being 
narrow  and  contracted  at  the  heels  only. 

We  prefer  to  recognize  a  total  contraction  where  the  whole  foot 
is  contracted,  and  is  smaller  than  its  fellow,  atrophied^  so  to  speak, 
consisting  in  a  contraction  of  the  quarter — when  it  is  principally 
narrow  in  those  quarters,  the  condition  extending  back  to  the 
heels — and  a  contraction  of  the  heels  when  this  is  well  marked 
from  the  quarters  to  the  heels  only.  A  coronary  and  a  plantar 
contraction  have  also  been  designated,  depending  upon  whether  it 
occurs  at  the  superior  or  inferior  part  of  the  foot,  and  there  are 
cases  where  the  contraction  is  intermediate,  that  is,  in  the  middle 
of  the  foot  only,  while  it  has  its  normal  size,  both  at  the  coronary 
band  and  at  the  plantar  border.  Siru/le  and  compUcated  contrac- 
tions have  also  been  named.  It  is  admitted  that  it  may  be  con- 
genital, though  rare ;  more  often,  however,  it  is  developed  by  it- 
self, as  a  result  of  special  causes. 

I.  Symptoms. — The  physiognominal  aspect  of  the  hoof-bound 
foot  is  characteristic,  and  it  is  by  this  that  we  shall  begin  the  symj)- 
tomatology  of  the  disease.  When  the  disease  is  total,  the  com- 
plete general  dimensions  of  the  foot  are  observed  to  be  smaller 
than  would  be  required  by  the  size  of  the  animal  affected;  most 
frequently  the  hoof  has  an  oval  form,  consequent  upon  the  antero- 
posterior diameter  exceeding  the  lateral,  which  is  generally  dimin- 
ished. In  the  contraction  of  the  quarters,  the  narrow  condition 
of  the  foot  is  specially  marked  from  the  centre  of  the  quarters 
back  to  the  heel.  In  contraction  of  the  heels,  the  diminution  is 
very  marked  from  the  centre  of  the  quarters  to  the  end  of  the 
heels,  so  that  the  two  sides  of  the  wall  converge  toward  each  other 
posteriorly  in  following  nearly  a  straight  line,  instead  of  the  cir- 
cular appearance  of  the  normal  state,  and  tfte  heels  have  princi- 
pally lost  their  round  appearance,  and  are  elongated,  and  even 
pointed  in  appeai'ance.     The  wall,  in  the  regions  where  the  con- 


642  OPERATIONS    ON    THE    FOOT. 

traction  is  more  marked,  that  is,  behind,  is  either  perpendicvilar 
to  the  ground,  or  even  oblique  downward  and  inward,  in  such  a 
way  that  the  coronary  circumference  is  greater  than  the  plantar, 
and  consequently  it  represents  an  inverted  truncated  cone. 

The  opposite  form  of  contraction,  that  of  the  coronary,  is  seldom 
seen,  and  we  may  ignore  it.  The  wall  is  irregularly  rough  and 
ramy,  and  without  its  shining  apj)earance.  The  heels  are  gener- 
ally high,  nearly  as  high  as  the  toe,  though  it  is  not  so  severely 
altered  in  cases  where  the  heels  only  are  contracted.  As  a  con- 
sequence of  the  contraction  of  the  plantar  border  of  the  wall,  the 
sole  seems  to  become  folded  in  the  direction  of  its  antero-posterior 
axis,  and  it  shows  a  much  greater  concavity  on  its  internal  face 
than  in  the  normal  state.  This  cavity  is  then  filled  by  the  frog, 
considerably  reduced  in  size,  thus  presenting  an  idea  of  the  sever- 
ity of  the  contraction.  Most  frequently  it  is  a  thin,  thready  body, 
flattened  on  its  sides  by  the  closing  of  the  bars ;  its  branches,  thin 
and  narrow,  resembling  two  bands  so  closely  resting  on  each  other 
that  the  lacunae  which  separates  them  is  no  more  than  a  narrow 
fissure,  which  will  scarcely  admit  the  introduction  of  the  thin 
blade  of  a  knife,  and  from  the  bottom  of  which  escapes  a  sero- 
purulent,  gray  or  blackish  liquid ;  the  lateral  lacunae  being  also 
transformed  into  two  narrow  and  deep  fissures,  filled  with  the 
same  fluid.  The  bars,  generally  high,  assume  a  direction  perpen- 
dicular to  the  ground,  instead  of  being  obUque,  as  in  the  normal 
state,  from  the  centre  of  the  foot  toward  its  circumference. 

In  all  the  regions  of  the  foot,  but  especially  at  the  wall,  the 
horn  is  so  dry  and  hard  that  sharp  instruments  cannot  cut  its  cor- 
tical covering,  while  it  is  at  the  same  time  brittle,  and  hence  nu- 
merous superficial  fissures  appear  at  the  quarters,  and  the  outside 
and  inside  toes,  the  frog  itself  being  hollowed  by  fissures  upon  its 
body  and  branches.  Sometimes  it  happens  that  the  bars  show 
deep  fissures,  running  from  above  downward,  to  the  extremity  of 
the  lateral  lacunae,  which  are  thus  continued  by  a  crack  of  the 
heel  up  to  the  skin  of  the  coronary  band.  There  is  often  a  sepa- 
ration of  the  wall  and  the  sole,  the  formation  of  what  has  been 
called  a  double  wall,  or  false  quarter.  Quarter  cracks  are  com- 
monly met  with  it.    Corns  are  frequently  seen  in  connection  with  it. 

"Whatever  may  be  the  form  of  the  contraction,  it  is  generally 
accompanied  by  pain,  manifested  by  change  of  position  while  at 
rest  and  by  lameness  when  in  action. 


DISEASES.  643 

If  only  on  one  side,  the  affected  leg  is  carried  forward,  and 
thus  reHeved  from  the  too  painful  pressure  which  would  take 
place  if  it  remained  in  a  vertical  direction  under  the  center  of 
gravity.  "When  both  feet  are  diseased,  the  horse  is  constantly 
moving  and  balancing  himself,  pointing  the  legs  alternately,  and 
sometimes  stretching  both  legs  forward,  as  in  laminitis,  but  always  ■ 
moving,  so  as  to  push  his  bedding  under  him  and  away  from  his- 
fore  feet. 

If  the  pain  is  slight,  there  is  only  a  stiff  gait,  and  the  animal 
hesitates  and  stumbles  easily.  But  if  the  disease  is  advanced  the 
lameness  is  great  and  the  animal  is  very  groggy  in  his  gait.  He 
fears  to  rest  on  his  heels,  which,  without  being  a  peculiar  charac- 
teristic, is  a  symptom  which  present,  however,  a  particularly  notice- 
able condition.  While  there  is  hesitation  in  the  action  of  resting, 
there  is  difficulty  in  that  of  the  shoulder.  This  is  principally 
observable  when  the  disease  affects  both  feet.  The  shoulders 
then  seem  to  be  fixed  to  the  trunk,  and  their  motion  forward  is 
very  limited.  The  symptoms  are  mostly  more  marked  when  the 
anunal  leaves  the  stable.  It  may  then  happen  that  the  pain  tem- 
porarily losing  somewhat  of  its  intensity  as  the  horse  is  moved, 
the  shoulders  become  more  free,  the  Hberty  of  action  returns, 
and  once  warmed  up,  the  animal  may  offer  a  totally  different  ap- 
pearance from  that  when  first  leaving  the  stable.  But  as  soon  as 
they  become  rested,  the  pain  returns  as  severely  as  before,  if  not 
more  so,  and  with  it  the  same  exhibitions  of  symptoms. 

The  examination  of  the  unshod  foot  while  it  is  warm,  shows 
the  extreme  sensibhty  of  the  heels.  The  foot  being  pared,  gen- 
erally one  may  observe,  in  the  region  where  the  contraction  is 
most  marked,  yellowish  or  reddish  discolorations,  evidences  of 
the  bruises  in  the  living  parts,  as  well  as  of  the  serous  or  bloody 
exudations  which  have  taken  place  on  theu-  surfaces.  These  indi- 
cations are  especially  abundant  on  the  level  of  the  sole  and  walL 
If  the  contraction  is  old,  there  is  at  that  point  a  purulent  mas» 
which,  when  removed,  leaves  a  caxity  which  sometimes  extends 
npward  under  the  quarters.  It  is  a  separation  of  the  wall,  of  twa 
or  three  centimeters  in  dej)th. 

An  important  observation  for  hoof-bound,  and  which  assists  in 
its  recognition,  is  the  increased  wear  upon  the  shoes  at  the  toe^ 
which  takes  place  not  only  when  animals  are  working,  but  also 
while  idle  in  the  stable,  as  the  result  of  pointing  and  scraping  the 


644  OPEEATIOXS    ON    THE    FOOT. 

stable  flooi-.  The  horse  which  has  both  feet  diseased  in  constantly 
in  motion,  to  such  an  extent  that  his  shoes  are  entirely  worn  in  a 
few  days. 

At  times  the  pain  is  so  great  that  it  gives  rise  to  general  symp- 
toms ;  the  animal  becomes  anxious,  loses  his  appetite,  refuses  his 
food,  lies  down  most  of  the  time,  and  rises  only  with  difficulty. 

II.  Cotnplications. — We  have  already  seen  that  quarter  cracks 
and  dry  cordis  are  common  affections  of  contracted  feet.  Exos- 
tosis of  the  phalangeal  region  is  also  commonly  met  in  such  feet, 
especially  side-bones.  Knuckling,  and  diseases  of  the  tendons 
and  of  their  sheaths  are  also  often  caused  by  contractions  of  the 
feet.  The  rest  of  the  foot  on  its  whole  surface  is  thus  perverted 
and  the  tendons  become  retracted,  painful  and  swollen. 

Navicular  disease  is  so  often  met  with  in  company  with  con- 
tracted feet,  that  one  disease  is  frequently  mistaken  for  the  other. 
Laminitis  has  been  said  to  be  also  one  of  the  complications  ;  if 
so,  it  is  at  least  quite  rare  in  its  occurrence. 

Tetanus  has  sometimes  been  observed  among  its  associations, 
and  Hartmann  attributes  the  development  of  so-called  idioj^athic 
cases  of  that  disease  to  this  condition  of  the  feet. 

The  emaciation  of  the  affected  leg  is  a  complication  seen  also, 
with  other  forms  of  lameness. 

III.  Pathological  Anatomy. — We  have  indicated  the  external 
changes  of  the  hoof.  The  tissues  that  have  been  long  enclosed  in 
the  contracted  foot  become  atrophied ;  molecular  changes  do  not 
take  place  as  in  the  normal  state ;  they  become  changed  in  asjoect, 
composition  and  properties  ;  they  become  denser  and  more  com- 
pact, and  are  no  more  able  to  fulfill,  to  the  same  extent,  then," 
physiological  functions. 

The  plantar  cushion  is  so  completely  pressed  upon  itself  that 
the  stratified  structure  of  its  fibrous  layers  can  scarcely  be  dis- 
tinguished, and  the  presence  in  the  interstices  of  the  yellow  fibrous 
substance  is  with  difficulty  observed.  It  forms  only  a  homogene- 
ous mass,  whitish  in  color,  resisting  in  consistency,  and  lardac- 
eous  in  aspect  The  dilated  bulbs  which  are  above  the  cushion 
are  also  considerably  diminished  in  size,  and  present,  when  cut 
through,  a  uniform  white  color,  its  composing  substance  being 
reduced  to  a  single  inelastic  mass. 

The  ungueal  phalanx  becomes  deformed  by  degrees,  loses  its 
circular  shape  and  becomes  of  an  elongated  oval  form.  Its  lateral 


DISEASES.  645 

faces  assume  a  perpendicular  direction ;  its  structure  is  modified ; 
its  substance  becomes  more  compact,  and  the  small  vascular  open- 
ings are  obliterated,  while  the  largest  are  increased  in  size.  The 
work  of  obliteration  is  specially  observable  at  the  patilobe  emi- 
nences, which  appear  to  be  crushed.  The  lateral  cartilages  are 
also  much  compressed,  condensed  and  modified  in  their  struc- 
ture. 

The  navicular  bone  is  also  compressed,  the  sheath  and  its  sup- 
port not  allowing  the  easy  play  of  the  tendons,  and  it  is  in  this 
way  that  navicular  disease  may  follow  hoof-bound.  But  there 
is  a  specially  noticeable  modification  in  the  keratogenous  appara- 
tus, which,  as  a  consequence  of  the  arterial  obliterations,  fails  to 
receive  freely  and  actively  the  necessary  amount  of  blood.  The 
horny  secretion  proper  to  the  podophyllous  tissue,  the  white  or 
soft  horn,  is  reduced;  the  podophyllous  tissue  itself  is  atro- 
phied ;  its  lamellae  are  less  prominent  and  their  separations  are 
diminished  in  dej^th  ;  the  adherence  of  the  podophyllous  or  kera- 
phyllous  tissues  still  exists  where  the  circulation  of  the  blood  is 
not  interrupted,  but  beyond,  they  are  easily  separated  and  often 
present  deep  excavations  toward  the  sole. 

If  hoof-bound  advances  slowly,  the  same  atrophy  of  the  sub- 
horny  tissues  takes  place.  Then,  however,  it  proceeds  by  degrees, 
the  tissues  accommodating  themselves  in  size  to  the  gradually 
diminishing  dimensions  of  the  cavity  where  they  are  contained, 
and  there  is  an  equal  proportion  between  the  size  of  the  hoof  and 
the  volume  of  the  tissues  enclosed  in  it.  These  being  less  com- 
pressed, there  is  less  pain.  In  this  manner  an  excessive  contrac- 
tion of  the  heels  may  sometim.es  exist  without  marked  lameness. 

IV.  Prognosis. — This  is  the  more  serious  as  the  disease  is 
more  developed.  Total  hoof-bound  if  excessively  tenacious,  and 
resists  the  best  curative  measures,  though  if  there  is  only  a  slight 
contraction  at  the  heels,  it  is  generally  amenable  to  judicious 
treatment.  The  duration  of  the  disease  is  an  important  factor  in 
the  question  of  the  success  of  the  treatment,  as  the  condition  of 
the  OS  coronae,  os  pedis,  navicular  bone,  sesamoid  sheath,  plantar 
cushion  and  the  atrophy  of  the  keratogenous  membranes  have  all 
to  be  taken  into  consideration. 

The  age  of  the  diseased  animal  and  any  existing  complications 
are,  of  course,  circumstances  which  influence  the  prognosis  in  an 
important  degree. 


646  OPERATIONS    ON    THE    FOOT. 

V.  Etiology. — Hoof-bound,  says  H.  Bouley,  is  not  a  simple 
fact,  produced  by  a  unique  cause  acting  always  in  the  same  man- 
ner :  it  is,  on  tbe  contrary,  a  very  complex  one,  to  the  production 
of  whicli  a  great  number  of  causes  of  various  character  and  inten- 
sity contribute  with  simultaneous  or  successive  effects. 

The  hygrometic  condition  of  the  horny  substance  is  a  principal 
feature  in  the  etiology  of  the  disease.  It  is  when  the  hoof  loses 
by  evaporation  the  moisture  which  it  should  contain  that  it  con- 
tracts as  all  organic  substances  do,  and  its  flexibility  returns  when 
by  sufficiently  long  immersion  in  a  liquid,  the  moisture  it  has  lost 
is  recovered.  Observation  proves  that  this  disease  often  finds  the 
conditions  of  its  presence  in  circumstances  which  induce  dryness 
in  the  part.  In  such  cases  the  foot  has  the  property  of  retracting, 
to  an  extreme  degree,  especially  toward  its  posterior  extremity, 
where  the  frog  is  situated,  constituted  as  it  is  of  a  softer  and 
more  depressible  substance  than -that  of  the  wall.  The  same  phe- 
nomena takes  place  in  the  living  structure  that  is  observed  upon 
the  hoofs  of  dead  feet ;  a  phenomenon  which  cannot  even  be  pre- 
vented by  filHng  their  cavity  with  plaster.  During  life  the  hoof  is 
constantly  permeated  by  a  current  of  fluids  which  penetrate  it 
from  its  depth  to  the  surface.  It  is  the  serous  food  that  the  hoof 
is  continually  absorbing  by  the  hygroscopic  properties  common  in 
living  tissues,  which  coitnterbalance  the  tendency  of  the  foot  to 
retract  upon  itself  and  keep  it  in  the  dimensions  required  for  the 
perfect  reception  of  the  parts  it  covers.  So  long  as  the  equilib- 
rium is  preserved  between  the  loss  of  this  fluid  by  evaporation 
and  its  renewal  through  the  perspiration  of  the  keratogenous 
apparatus,  the  hoof  preserves  its  physiological  form ;  but  if  this 
equilibrium  is  destroyed  by  an  excess  of  the  loss,  then  the  condi- 
tion occiu's  for  the  reti-action  of  the  hoof  and  the  infliction  upon 
the  parts  underneath  of  an  excessive  and  painful  pressure. 

This  explains  why,  as  proved  by  observation,  lameness  in 
general  and  that  of  contracted  heels  especially,  is  more  frequent 
in  warm  than  in  moist  seasons.  Long  standing  in  the  stable  is 
also  an  efficient  producing  cause.  The  feet  become  diy  upon  a 
constantly  dry  bedding,  and  here  also  the  influence  of  inaction 
must  be  taken  into  account.  The  disease  is  commonly  found  in 
stabulation,  but  seldom  when  the  animal  is  in  pasture ;  and  when 
it  has  existed  it  often  disappears  in  the  latter  circumstances. 

The  alternation  of  dampness  and  dryness  also  influences  per- 


DISEASES.  647 

liaiDS  more  the  genesis  of  the  disease  than  dryness  alone.  A  foot 
too  much  impregnated  with  dampness,  which  is  afterward  left  to 
thfe  air,  becomes  harder  than  a  normal  one  placed  in  the  same  con- 
ditions. It  retracts  easier,  also.  It  is  probable  that  the  water,  in 
softening  the  superficial  layers  of  the  wall,  also  renders  the  evap- 
oration of  the  Hquids  of  its  deep  parts  more  active.  In  the  ordi- 
nary condition  of  the  foot,  the  evaporation  is  diminished  by  the 
impermeability  of  the  external  hoof,  which  it  owes  to  its  density  ; 
but  where  this  hoof  is  softened  by  maceration,  its  fibres,  partly 
disintegrated  by  the  dissolution  of  the  glutinous  substance  which 
keeps  them  as  a  compact  mass,  allow  the  air  to  penetrate  in  their 
interspaces ;  air  which  dries  them  to  a  certain  depth ;  hence  a 
groportionate  movement  of  retraction  of  the  entire  hoof  upon 
itself.  This  evil  effect  of  an  excess  of  moisture  explains  how  it  is 
that  poultices  or  other  moist  ajDplications  which  horse  attendants 
abuse  so  frequently,  may  give  rise  to  results  entirely  opjoosite  to 
the  one  in  view,  and  why  the  hoof  becomes  dry  and  brittle,  if  not 
contracted.  These  topical  appHcations  take  off  from  the  cortical 
layer  of  the  foot  its  protecting  varnish,  and  expose  it  to  lose  its 
water  of  growth. 

Some  of  the  practices  in  shoeing  contribute  also  to  the  dessi- 
cation  of  the  hoof ;  such  is  principally  that  which  consists  in  rasp- 
ing the  wall  from  the  coronary  band  to  the  plantar  border ;  as 
also  the  too  long  continued  contact  of  a  hot  shoe  with  the  foot. 

Shoeing  itself  promotes  the  same  result,  as,  protected  by  a 
shoe,  the  foot  no  longer  wears  normally  and  grows  beyond  nor- 
mal limits.  The  mass  of  hoof  which,  in  the  process  of  growth, 
has  gone  beyond  the  inferior  limits  of  the  podophyllous  fissures,  is 
no  longer  in  contact  with  the  li\ing  parts  beneath,  and  they  cease 
to  be  impregnated  by  the  fluids  which  are  thus  constantly  allowed 
to  evaporate.  It  then  dries  up  by  evaporation  and  become  hard, 
and  retracts  upon  itself  in  such  a  manner  that  the  circumference 
of  the  foot  in  the  lateral  diameter  diminishes  more  or  less,  espec- 
ally  posteriorly,  and  thus  forces  the  incurvations  of  the  sole  and 
of  the  bars  (H.  Bouley).  If  a  horse  remains  shod  for  several 
months  without  having  his  feet  trimmed  and  pared  by  the  black- 
smith, these  are  seen  contracting  by  degrees,  as  they  increase  in 
length,  and  soon  assume  the  aspect  of  hoof-bound. 

But  these  are  not  the  only  effects  of  shoeing  in  the  etiology  of 
contraction.     On  the  contrary,  this  practice  is  the  most  common 


648  OPEKATIONS    ON    THE    FOOT. 

cause  of  this  lesion  of  the  hoof  if  not  practiced  with  the  intelli- 
gence it  requires.  We  have  said,  in  speaking  of  corns,  that  they 
were  proofs  of  bad  shoeing.  The  same  might  be  said  of  the  con- 
traction. Moreover,  corns  generally  indicate  great  errors  in  shoe- 
ing, while  hoof-bound  demonstrates  the  ignorance  of  the  physiology 
of  the  hoof,  which  in  action  must  enjoy  the  necessary  elasticity  to 
relieve  the  contact  with  the  weight  of  the  body  upon  the  ground. 
No  doubt  the  theory  of  Bracy  Clark  exaggerates  the  degree  of 
elasticity  in  admitting  a  great  power  of  dilatation  of  the  hoof,  but 
it  is  an  opposite  excess  to  deny  it  entirely.  The  dilatation  of  the 
hoof,  though  Umited,  is  evident  at  the  heels;  especially  on  feet 
which  have  never  been  shod  (Merche).  There  is  especially  in  the 
inside  of  the  foot,  in  the  soft  and  supple  parts,  a  certain  compres- 
sibility of  the  hoof,  which  is  often  overlooked,  and  which  is  inter- 
fered with  by  a  too  narrow  or  unmethodical  shoeing. 

The  external  dilatation  of  the  hoof  is  comparatively  limited, 
but  on  the  inside  of  the  hoof  there  is,  in  the  posterior  pai-t  of  the 
foot  (especially  in  the  fore  feet)  a  movement  downward  and  out- 
ward of  the  OS  pedis,  for  whether  the  normal  elasticity  of  the  hoof 
is  necessary,  either  by  the  physical  and  physiological  constitution 
or  the  arrangement  of  the  constituent  parts  of  the  hoof.  Quite 
often,  then,  shoeing,  especially  if  too  tight,  resists  the  internal 
pressure.  Even  admitting  that  the  dilatation  of  the  heel  is  nor- 
mal, shoeing  which  would  prevent  it,  would  always  produce,  at 
the  time  of  rest,  a  pressure  uj)on  the  hoof  which  would  limit  the 
comj)ressibility  of  the  deep,  soft  tissues.  The  frog,  especially, 
formed  of  a  softer  horn,  and  placed  under  the  plantar  cushion, 
must  receive  this  gradual  pressure,  which  diminishes  by  degrees 
as  the  hoof  becomes  harder,  and  is  reduced  considerably  as  it 
reaches  the  external  horny  layers. 

The  errors  committed  in  shoeing,  and  which  predispose  to 
hoof-bound,  vary.  The  first  is  in  the  manner  in  which  the  foot  is 
pared  ;  too  often  the  heels  are  lowered  to  excess,  while  the  toe  is 
allowed  to  remain  too  long  ;  too  often,  again,  the  bars  are  hollowed 
too  deeply',  thinned  too  much,  as  well  as  the  frog.  The  wall  then 
tends  to  retreat,  as  it  is  no  longer  protected  behind.  In  reducing 
the  height  of  the  heels,  in  opening  them,  the  tendency  to  contrac- 
tion is  increased ;  the  thinned  hoof  dries  up,  the  lowered  heels 
lose  their  strength,  and  the  bars  are  unable  to  perform  their 
functions. 


DISEASES.  649 

A  vicious  adjustment  also  contributes  to  contraction.  When  the 
shoe  is  so  prepared  that  its  upper  face  is  concave,  and  its  branches 
form  a  plane  inclined  from  without  inward,  and  when  this  face 
extends  back  to  the  heels,  there  is  a  circular  pressure  produced 
upon  the  inferior  border  of  the  wall.  This  is  a  case  in  which  the 
foot  has  a  tendency  to  droj),  pressed  in  as  it  also  is  by  the  weight 
of  the  body  as  the  foot  rests  on  the  ground. 

Another  wrong  practice  is  to  place  the  nails  too  near  the  heels. 
The  fixing  of  the  shoe  on  the  foot  tends  always  to  jDroduce  con- 
traction, as  Bracy  Clark  observed ;  it  especially  prevents  the  wide- 
ening  of  the  hoof,  as  remarked  by  Eodet  and  Coleman.  But  this 
effect  of  the  nails  is  well  marked  at  the  heels,  where  they  prevent 
the  dilatation  of  that  part  of  the  foot. 

These  effects  of  shoeing  are  to  be  observed  so  much  the  more 
rapidly  and  seriously  when  the  hoof  is  thicker,  denser,  and  of  a 
finer  structure,  as  it  is  observed  in  small  feet.  In  these  feet,  the 
hoof  grows  more  rapidly,  and  is  on  this  account  more  ready  to 
contract.  Let  us  now  consider  that  this  effect  of  shoeing  is  jjer- 
manent,  and  that  to  the  effect  of  a  first  shoeing  comes  to  be  added 
that  of  a  second,  of  a  third,  and  so  on,  and  we  can  readily  under- 
stand how  truly  the  great  number  of  contracted  heels  one  may 
meet  with  can  be  attributed  to  erroneous  shoeing. 

Inaction  is  also  an  important  cause,  as,  sa^'s  Turner,  the  horse 
is  by  natui-e  destined  to  be  always  in  motion ;  it  is  a  condition  of 
its  health,  and  it  is  on  account  of  this  condition  that  in  the  state 
of  nature  he  is  free  from  contracted  heels.  It  is,  on  the  contrary, 
because  the  domesticated  horse  is  confined  within  a  stall  for  hours 
and  days,  that  his  feet  become  contracted.  We  have  seen  colts 
raised  without  exercise,  whose  feet  were  contracted  before  they 
were  shod. 

Contraction  of  the  heels  is  often  the  result  of  other  diseases  of 
the  hoof,  and  of  other  lameness.  It  is  commonly  associated  with 
corns,  navicular  disease,  punctured  wounds  of  the  plantar  region, 
accompanied  with  long  sensitiveness  of  the  posterior  parts  of  the 
foot,  after-diseases  of  the  frog,  thrushes,  side  bones,  phalangeal 
articular  diseases;  in  fact,  after  all  affections  of  long  standing, 
even  if  they  have  their  seat  in  the  upper  segment  of  the  frog. 

Finally,  heredity  has  been  named  as  one  of  the  causes.  This 
cannot  be  denied  as  to  some  breeds,  principally  of  meridional 
climates,  as  a  consequence  of  the  organization  of  their  feet,  which 


650  OPEEATIONS    ON    THE    FOOT. 

are  usually  small.  The  proposition  lias,  however,  we  believe, 
been  exaggerated.  This  is  proved  by  the  Arabian  horse,  which, 
though  accused  of  the  vicious  confirmation  from  heredity,  has, 
according  to  Vallon,  Crompton,  and  others,  the  most  admirable 
comformation  of  his  feet,  when  it  has  not  been  shod.  It  is  broad, 
with  good  heels,  neither  too  high  nor  too  low,  well  open,  well 
j)rominent,  wide  frog,  the  external  wall  being  strong  and  well 
developed.  In  the  horses  of  Caramania,  Ajiatolia,  Syria,  and  those 
of  the  Arabs,  which  are  constantly  in  the  desert,  from  Bagdad 
and  Bassaro  to  the  Gulf  of  Persia,  the  foot  is  handsomely  made, 
and  free  from  all  contractions  when  it  has  been  exempted  from 
shoeing. 

VI.  Treatment. — Prophylaxy  plays  an  important  part  in  the 
treatment  of  this  disease.  It  is  easier  and  especially  more  rational, 
to  prevent  than  to  cure  it  when  once  estabhshed. 

One  of  the  first  indications  is  to  prevent  the  drying  of  the  hoof, 
to  efi"ect  which  baths  and  poultices  have  been  commonly  used — 
the  latter  formed  of  cow  manure,  of  clay,  etc. — or  by  the  applica- 
tion of  greasy  substances,  in  order  to  diminish  the  evaporation  of 
the  water  of  the  hoof.  Some  practitioners  are  accustomed  to  use 
tar  and  various  hoof  ointments.  The  number  of  preparations 
brought  into  use  is  considerable,  and  in  respect  to  some  of  these, 
the  secret  of  which  has  been  kept  by  the  inventors,  the  effects 
have  been  entirely  different,  and  the  hoof,  instead  of  preserving 
its  natm-al  good  condition,  has  been  altered  in  its  qualities.  "  It 
is  not  with  ointment,"  says  Hartman,  "that  the  hoof  injured  by 
the  blacksmith  can  be  repaired.  It  is  by  good  shoeing,  and  never 
otherwise.  The  workman,  to  excuse  himself,  attributes  to  the 
quality  of  the  hoof  the  origin  of  the  mischief  he  has  done."  Hoof 
ointment  never  gives  to  the  hoof  its  natural  polish,  but  many  oint- 
ments, by  becoming  rancid,  take  off  that  which  the  blacksmith  has 
left.  The  ii-ritating  ingredients  which  compose  them  sometimes 
produce  the  same  results.  This  does  not  mean  that  a  reasonable 
application  of  ointment  is  not  necessary ;  but  to  act  favorably  it 
is  essential  that  one  coat  should  be  carefully  removed  before 
the  apphcation  of  another.  Otherwise,  the  new  will  fail  of  its 
proper  effect,  and,  on  the  contrary,  the  old  coat,  by  its  alteration, 
will  give  rise  to  a  deterioration  of  the  hoof,  especially  in  affecting 
the  substance  which  unites  the  horny  elements,  and  would  reduce 
it  to  fine  powder.     And,  again,  ordinarily  it  is  only  the  wall  which 


DISEASES.  651 

is  greased,  the  hoof  of  the  sole  and  of  the  frog  being  left  without, 
though  they  may  be  in  equal  need  of  it.  The  best  hoof  ointment 
is  made  of  lard,  a  small  quantity  of  wax  or  turpentine,  sometimes 
mixed  with  tar.  Glycerine  is  very  useful,  to  give  the  hoof  supple- 
ness when  it  has  become  hard ;  it  is  applied  by  friction,  after  the 
foot  has  been  well  washed  and  dried.  In  the  majority  of  cases 
poultices  are  preferable  to  mucilaginous  baths. 

Greasing  is  necessary  for  horses  which  are  much  exposed  to 
dampness,  and  is  as  good  for  the  sole  and  frog,  as  for  the  wall. 
It  is  applicable,  also,  to  feet  which  have  to  stand  on  dry  bedding. 
Feet,  which,  on  account  of  diseased  conditions,  requii-e  to  be  fre- 
quently soaked  or  poulticed,  ought  also  to  be  greased.  Bedding 
of  fine  sand  and  of  sawdust  has  been  recommended.  It  is  well, 
also,  to  place  horses  upon  marshy  lands.  All  these  measures  may 
"be  advantageous  if  the  feet  are  properly  shod. 

Good  shoeing  is  the  essential  prophylaxy  of  hoof-bound ;  we 
must  avoid  all  improper  practices  likely  to  promote  desiccation 
and  contraction  of  the  foot,  such  as  abuse  of  the  rasp ;  too  long 
application  of  the  heated  shoe  when  fitting  ifc  to  the  foot ;  the 
lowering  of  the  heels ;  the  excessive  paring  of  the  frog  or  of  the 
bars ;  the  bad  fitting  of  the  shoe  ;  useless  calks ;  too  many  nails 
in  the  quarter  or  near  the  heels — all  these  errors  must  be  carefully 
avoided.  The  foot,  moreover,  must  not  be  allowed  to  grow  too 
long.  The  shoeing  should  be  renewed  at  least  monthly,  even  if 
the  shoe  is  not  worn.  And  lastly,  the  horse  must  not  be  allowed 
too  long  periods  of  inactivity. 

It  has  been  proposed  to  abolish  the  custom  of  shoeing,  but  in 
the  present  conditions  and  modes  of  using  the  horse  this  is  im- 
possible. The  feet,  deprived  of  their  accustomed  protection,  would 
soon  become  painful,  and  only  by  keeping  the  animal  in  the  coun- 
try could  the  feet  be  suffered  to  remain  unshod. 

Several  modes  of  shoeing  have  been  invented  to  prevent  con- 
tractions in  feet  which  are  predisposed  to  them.  Some  are  un- 
doubtedly beneficial,  but  they  must  be  used  as  an  ordinary  shoe- 
ing, and  not  reserved  until  the  access  of  the  disease.  Good 
ordinary  shoeing  is  often  all  that  is  required,  but  no  doubt  better 
and  quicker  resvdts  will  be  obtained  by  the  shoe  with  short  branches, 
with  the  flat  shoe,  or  with  the  Charlier  shoe. 

The  half  shoe,  the  shoe  loith  short  branches  {fer  a  croissant), 
originally  recommended  by  Cesar  Fiaschi,  then  by  Solleysel,  La- 


652 


OrEKATIONS    ON    THE    FOOT. 


Fig.  498.— Short-branched  Shoe. 


fosse,  Sr.,  and  Crompton,  is 
an  ordinary  shoe,  made  light, 
with  very  short  branches 
(Figure  498),  which  when 
put  on  protects  the  toe,  the 
mammse  (outside  or  inside 
toe),  and  the  anterior  parts 
of  the  quarter  in  such  a  man- 
ner that  the  parts  posterior 
to  these  remain  uncovered, 
and  rest  du-ectly  on  the 
ground.  Thus  shod,  the 
shoe  is  almost  in  its  natural 
condition;  it  rests  on  the 
ground  by  its  posterier  part, 
and  the  heels  are  made  to 
contribute  to  the  movement 
of  expansion  of  the  elastic 
parts  of  the  foot.  This  shoe,  then,  has  real  advantages,  if  the 
posterior  part  of  the  foot  is  yet  normal,  but  if  the  heels  are  low 
and  the  frog  atrophied,  it  ceases  to  be  of  service. 

The  flat  shoe,  or  the  shoe  vnth  base  {fer  a  siege),  first  recom- 
mended by  Osmer,  Morcroft,  and  more  recently  by  Miles,  Ein- 
siedel  and  Hartmann,  is  the  style  generally  adopted  at  the  pre- 
sent time  in  Saxony,  and  in  various  parts  of  Germany,  as  well  as 
in  England.  In  France  it  has  found  its  way  through  the  benefits 
observed  by  a  few  veterinarians.  It  is  a  shoe  almost  equal  in 
thickness  to  its  width,  square,  so  to  speak,  but  as  hght  as  possi- 
ble; the  internal  border  of  the  foot  surface  being  hollowed  or 
dished  in  order  not  to  come  in  contact  with  the  sole,  while  the 
part  which  rests  on  the  plantar  border  of  the  wall  is  perfectly  flat 
and  horizontal.  The  heel  portion  is  rounded,  and  covers  mostly 
the  heels  of  the  foot  where  the  borders  of  the  shoe  become  per- 
fectly adapted  to  the  borders  of  the  wall,  to  the  remotest  part  of 
the  heels,  and  preserves  the  same  contour  until  it  reaches  the  frog. 
The  shoe  nowhere  projects  beyond  the  border  of  the  Mall ;  it  is 
only  toward  the  toe  that  it  is  slightly  raised  and  has  a  small  clip. 
The  groove  of  the  English  shoe  renders  its  application  better 
than  the  peculiar  nail  holes  of  the  French.  Five  or  six  nails  are 
usually  sufficient.     This  shoe  allows  the  dilatation  of  the  foot  in 


G-)3 


nil  its  limits,  and  while  protecting  the  heels,  does  not  predispose 
to  their  contraction.  For  its  application,  the  j)lantar  border  only 
needs  paring.  That  of  the  sole,  the  frog  and  the  bars  must  be 
carefully  avoided. 

For  the  shoeing  of  Charlier,  or  ^^eri-/jto»tor  (Figs.  499  and 
500)  the  part  of  the  hoof  which  is  most  exposed  is  protected.    It 


Fig.  499.— Foot  prepared  for  Charller  Shoe.       Fia.  500.— Foot  Shod;  Charlier's  Method. 


preserves  entirely  all  the  other  parts  of  the  plantar  surface  in  such 
a  way  that,  as  in  the  conditions  of  nature,  it  is  only  by  the  fact  of 
the  wearing  of  the  shoe  that  the  excess  of  hoof  is  gradually  re- 
moved. The  foot  shod  by  this  process  is  provided  at  its  inferior 
border  with  a  metallic  bar,  often  greater  in  thickness  than  in 
width,  lodged  in  a  groove  made  exclusively  in  the  wall.  This  bar 
adapts  itself  in  its  internal  circumference  to  the  contour  of  the 
sole,  which  projects  beyond  the  border  of  the  groove,  because  all 
its  thickness  has  been  preserved  as  well  as  that  of  the  frog  and  of 
the  bars.  In  this  way  the  rest  of  the  foot  receives  its  adjustment 
from  the  shoe  itself,  and  by  the  regions  of  the  plantar  surface 
which  it  surrounds.  This  result  does  not,  howevei',  take  place 
immediately,  or  when  the  foot  is  recently  shod ;  but  by  degrees, 
and  as  the  shoe  wears  out,  the  time  arrives  when  the  horse  walks 
both  on  his  shoe  and  the  sole  of  his  foot.  Owing  to  the  general 
equalization  of  the  friction  any  partial  wear  is  thus  diminished, 


654:  OPERATIONS    ON    THE    FOOT. 

and  the  important  result  is  secured  of  reducing  the  weight  of  the 
shoe  without  the  necessity  of  too  frequent  renewals,  experience 
having  jDroved  that  for  the  fore-feet  it  is  quite  as  durable  as  the 
ordinary  shoe  of  twice  its  weight,  but  which  from  the  manner  in 
which  it  is  applied  suffers,  unaided,  the  effects  of  the  pressure 
and  friction  (H.  Bouley).  As  in  the  action  of  paring  the  foot  only 
the  projecting  portions  of  the  wall  at  the  inferior  border  are  re- 
moved, the  preserved  parts  of  the  plantar  region  resist  the  move- 
ment of  retraction,  and  thus  prevent  its  occurrence  in  a  transverse 
direction.  Again,  as  the  thickness  of  the  Charher  shoe  is  greater 
than  its  width,  it  possesses  a  certain  elasticity  and  adapts  itself  to 
the  successive  movements  of  the  dilatation  and  contraction  of  the 
horny  box,  however  lunited  they  may  be. 

We  may  now  refer  to  some  special  modes  of  shoeing,  recom- 
mended as  preventive  of  contracted  heels,  but  which  seem  to  us 
to  possess  inferior  advantage  to  the  preceding.  "We  first  find  the 
unilateral  shoe  of  Turner,  which,  according  to  that  veterinarian, 
reheves  the  foot  from  pressure  upon  the  heels  by  placing  the  nail 
holes  on  the  toe  and  the  external  branch  only.  Tui'ner  recom- 
mends also  the  conservation  of  the  frog  and  that  of  the  bars,  and 
it  is  probably  to  this  that  the  success  he  has  obtained  by  that 
mode  of  shoeing  is  due. 

Coleman  recommended  a  shoe  very  thick  at  the  toe  and  thin 
at  the  heels,  the  toe  being  three  times  as  thick  as  the  heels.  This 
veterinarian  thought  that  by  this  shoe  the  animal  was  obliged  to 
rest  on  his  frog ;  at  the  same  time  the  nails  were  driven  in  the 
toe  principally,  so  as  to  allow  the  dilatation  of  the  heels.  This 
shoe  has  no  real  advantages,  and  predisposes  to  corns. 

The  bar  shoe  is  of  some  utility  when  the  frog  is  well  developed, 
by  placing  on  that  part  the  pressure  of  the  foot,  and  leaving  the 
heels  free.  But  it  often  fails  in  contracted  heels,  because  in  aj)ply- 
ing  it  these  parts  require  to  be  pared  down,  in  order  to  increase 
the  prominence  of  the  frog,  and  a  condition  is  thus  produced 
which  does  not  exist  in  contracted  feet.  The  same  may  be  said  of 
the  Charlier  bar  shoe.  The  objections  stated  and  the  reasons 
suggested  are  true  of  all  the  various  shoes  designed  to  adjust  the 
frog  pressure. 

The  hinge-shoe  or  articulated  (Figs.  501  and  502)  of  Bracy 
Clark  and  Vatel,  and  the  half-shoe  of  Sempastous,  of  Peillard, 
also  possess  but  a  doubtful  utility.     Practice  has  not  confirmed 


655 


Fig.  502.— Hinged  Shoe.  FiG.  502.— Articulated  Shoe. 

the  hopes  of  their  inventors.  They  are  difficult  to  make,  easily 
injured,  and  of  small  solidity,  and  their  advantages  are  wholly  of 
the  problematic  order. 

Mayer  has  recommended  a  shoe  whose  internal  border  is 
thicker  than  the  external,  in  such  a  way  that  the  plane  of  the 
plantar  surface  of  the  shoe  shall  be  incHned  outward,  and  instead 
of  the  concavity  of  the  ordinary  shoe,  where  the  foot  is  pressed 
when  in  position  of  rest,  there  is  a  convexity  which  promotes  and 
even  increases  the  dilatation  of  the  foot.  This  mode  of  shoeing 
has  for  its  inconvenience  the  exj)osure  of  the  sole  to  contusions. 
It  supposes  an  extensive  expansion  of  the  foot  which  is  not  natu- 
ral ;  the  horizontal  plane  is  amply  sufficient  in  ordinary  circum- 
stances. We  have,  however,  used  it  advantageously  in  j)reventing 
the  pressure  of  the  sole  against  the  shoe  by  means  of  a  sheet  of 
gutta-percha.  "We  have  used  it  in  almost  complete  contraction, 
and  we  think  we  have  noticed,  with  Hartmann,  that  the  dilatation 
once  started  by  a  mechanical  means,  not  too  severely  appUed, 
nature  continues  it,  with  the  assistance  of  that  style  of  shoe.  In- 
stead of  giving  that  special  shape  of  the  shoe  in  its  entire  length, 
it  has  been  proposed  to  have  it  only  at  the  branches ;  each  heel 
presenting  at  its  internal  border  a  thickness  double,  or  even  treble, 
that  of  the  external,  by  which  the  shoe  is  inclined  outward  by  its 
plantar  and  becomes  horizontal  by  the  ground  face.  It  is  flat  at 
the  toe  and  the  quarters,  and  is  the  shoe  with  slippers  of  de  la 
Broue  (Fig.  503),  of  SoUeysel,  and  that  Vatrin  has  used  in  pro- 
posing to  have  the  internal  half  of  the  width  of  the  shoe  inclined 
(Fig.  504).     It  thus  resembles  the  shoe  geneU  or  with  ears,  of 


656  OPERATIONS    ON    THE    FOOT. 


Fig.  503.— Shoe  of  de  la  Broue. 


Fig.  504.— Vatrin's  Shoe. 

whicli  we  shall  speak  hereafter.  This  shoe  is  only  indicated  when 
the  heels  are  already  contracted ;  they  have  no  indication  as  pro- 
puylastic  shoeing. 

The  shoe  with  slippers  is  indeed  a  shoe  which  in  some  cases 
may  cure  contraction.  "  If  the  results  obtained  have  not  been 
very  satisfactory,"  says  Defays,  "  this  depends  not  upon  the  shoe, 
but  arises  from  the  defective  manner  in  which  the  foot  was  pared. 
To  be  e£&cacious  in  that  shoeing  the  heels  must  be  left  alone,  and 
the  sole  and  the  bars  must  be  well  thinned.  It  is  true  that  in  this 
way  the  foot  is  in  the  most  favorable  condition  for  contraction, 
but  the  circulation  is  rendered  easier  in  the  tissues  underneath, 
and  the  effects  of  the  thinning  of  the  hoof  are  diminished  by  the 
resistance  opposed  to  contraction  by  the  inchned  planes  of  the 
branches  of  the  slipper.  The  same  may  be  said  of  the  shoe  of 
de  Belleville,  also  recommended  by  Solleysel,  and  for  whose  appH- 
cations  the  foot  has  to  be  carefuUy  pared.  We  feel  assured  of  the 
propriety  of  recommending  the  use  of  the  inclined  plane  of  the 
branches  of  the  shoe  with  the  presence  of  a  small  clip  on  the 
inner  borders  of  the  heels,  such  as  proposed  by  Vatrin. 

Attempts  have  been  made  to  dilate  the  contracted  foot  and  to 
cause  its  return  to  its  normal  dimensions  by  mechanical  means. 
The  shoe  vyith  ears  (Fig.  505)  has  been  devised  for  this  pur2iose. 
This  is  a  shoe  pro\ided  on  the  inner  border  of  each  heel  with 


657 


an  oblique,  blunt,  sometimes  perpendicular  cli}:),  resting  upon  the 
bars,  which  have  been  previously  hollowed  out  for  its  reception, 
the  design  of  which  is  to  resist  the  return  of  the  hoof  which  has 
been  dilated,  to  its  former  contracted  condition.  Kuinien  had 
sj^oken  of  this  shoe  as  early  as  1618.  It  was  put  on,  after  the 
dilatation  of  the  hoof  with  the  farrier's  nippers,  applied  on  each 


FiG.  505.— Shoe  with  Ears. 


Fig.  506.— Jarrier  Spreader. 


side  of  the  quarter,  the  sole  being  entirely  removed.  In  oui-  days 
this  operation  of  removing  the  sole  is  considered  useless,  and  in- 
stead of  the  nippers  of  the  farrier,  dilators  are  used,  under  the 
name  of  spreaders  (desencasteleur).  The  oldest  kuo^vTi  form  is 
that  of  Jarrier  (Fig.  506).  This  is  composed  of  two  curved 
branches,  11  centimetres  in  length,  articulated  at  one  of  theu-  ex- 
tremities like  the  ordinary  compass,  at  which  point  there  is  a 
screw  of  peculiar  form  by  which  £he  branches  are  closed  or  opened 
at  will,  the  other  extremity  having  a  strong  claw  projecting  out- 
ward. These  claws  are  appUed  inside  of  the  bars,  toward  the 
heels,  which  are  previously  thinned  out,  and  by  manipulating  the 
screw  the  hoof  is  dilated  to  the  extent  desired.  The  shoe  is  then 
used  like  an  ordinary  one,  both  heels  being  armed  with  a  clip  on 
the  internal  border,  the  clijps  resting  on  the  heels  of  the  foot, 
which  have  been  first  opened  with  the  drawing  knife.  This  mode 
of  treatment  proved  successful  with  Lafosse  and  others  who  ex- 
perimented with  it  at  the  Saumiu'  school.  Under  various  experi- 
ments, the  desencasteleur  has  changed  its  form.  Thus,  Lafosse 
has  arranged  the  two  branches  to  run  separately  upon  a  transversal 


658 


OPEKATIONS    ON    THE    FOOT. 


Fig.  507— Lafosse  Desencasteleur. 


rod  like  an  ordinary  vice,  in  which  form  the  branches  are  shorter, 
and  more  power  is  obtained  (Fig.  507).  There  are  many  other 
improvements  which  we  cannot  mention  for  lack  of  sj)ace. 

Instead  of  applying  the  dilatation  upon  the  hoof,  and  after- 
ward using  a  shoe  which  is  closely  adapted  to  the  dilatation  thus 
obtained,  spreading  shoes  have  been  used.  In  the  method  of 
Jarrier,  the  shoe  has  to  maintain  the  hoof  in  the  condition  of 
dilatation  which  has  been  accomplished  by  the  instruments  of  ex- 
pansion. It  is  a  very  dehcate  and  difficult  operation,  so  far  as  the 
jDroper  dilatation  of  the  foot  is  concerned,  requiring  the  closest 
adaptation  between  the  clips  of  the  shoe  and  the  parts  of  the  wall 
upon  which  they  rest.  An  error  of  a  few  millimetres  only  is  suffi- 
cient to  defeat  the  desired  result ;  and  the  shoe,  moreover,  must 
be  taken  off  at  each  operation.  To  avoid  this,  special  shoes,  which 
would  act  also  as  dilators,  were  invented.  It  was  not,  however,  a 
new  idea;  La  Gueriniere  had  as  early  as  1733  prepared  a  shoe 
composed  of  three  pieces — one  median,  corresponding  to  the  toe, 
and  two  laterals,  in  connection  with  the  quarters ;  these  latter  are 
respectively  articulated  with  the  first,  and  have  each  three  nail- 
holes.  When  this  shoe  was  fixed  upon  a  foot,  whether  unsoled 
or  not,  its  branches  were  spread  apart  by  a  plate  left  in  place,  and 
by  increasing  by  degrees  the  length  of  the  plate,  a  gradual  and 
increasing  dilatation  of  the  hoof  was  obtained.  Gaspard  Saunier 
improved  upon  this  shoe  by  placing  on  the  internal  border  of  the 
branches,  cranks,  with  a  plate  placed  crosswise  and  resting  upon 
them  (Figs.  508  and  508a).  The  objection  to  this  shoe  is  that  it 
cannot  remain  on  the  foot  except  when  the  animal  is  at  rest,  as 
when  he  is  at  work  it  soon  becomes  loosened ;  besides  which  it  is 
difficult  to  make  properly. 


659 


Fig.  508.— Spreading  Shoe. 


Fig.  50Sa.— a  Better  For 


Holland  has  contrived  an  articulated  shoe  in  three  pieces,  the 
two  lateral  pieces  being  kept  apart  by  double  steel  springs,  which 
press  upon  them  from  the  toe  on  their  internal  border,  and  thus 
effect  the  desired  dilatation.  Hatin  has  a  simpler  shoe  (Fig.  509). 
It  is  a  light  shoe,  with  nail-holes  dis- 
tant from  the  heels,  and  provided  on 
the  internal  border  with  a  small  chp, 
upon  which  rests  a  V  spring,  fixed  by 
its  point  upon  the  toe  of  the  shoe. 
The  branches  of  the  spring  lodge  in 
the  hollows  of  the  sole  and  of  the  frog, 
and  press  upon  the  shoe,  and  thus  pro- 
duce a  slow  dilatation.  Steinhoff  has 
also  invented  a  shoe  with  springs.  It 
has  recently  been  proposed  to  obtain 
the  dilatation  by  means  of  a  strong 
sole  of  cautchouc,  placed  between  the 
shoe  and  the  foot,  leaving  the  frog  full ; 
very  thin  where  it  rests  upon  the  shoe  and  the  foot,  and  becoming 
thicker  toward  the  inner  border  of  the  shoe,  which  it  overlaps. 
First  it  rests  in  the  groove  of  the  bars,  and  then  portrudes  upon 
the  flat  of  the  shoe,  and  bears  on  the  ground  at  the  time  of  rest. 
This  elastic  mass,  compressed  at  the  moment  of  contact,  sHghtly 
dilates  the  shoe,  which  is  articulated,  or,  what  is  better,  very  nar- 
row at  the  toe,  and  square  ;  the  heels,  also,  are  thus  slowly  and 
gradually  dilated. 


Fig  509.— Hatin's  Shoe. 


660 


OPERATIONS    ON    THE    FOOT. 


Goodwin  also  has  invented  a  very  ingenious,  but  too  compli- 
cated shoe,  comjiosed  of  three  articulated  pieces.  From  the  center 
of  the  median  piece  a  prolongation  of  iron  extends  to  the  back  of 
the  frog,  and  is  of  sufficient  thickness  to  be  perforated,  the  hole 
having  a  thread  through  which  a  screw  is  introduced,  running  on 
each  side.  The  branches  of  the  shoe  have  three  nail-holes,  and 
from  the  inner  border  of  the  heel  rises  a  clip  so  turned  as  to  rest 
on  the  origin  of  the  bar.  The  mechanism  of  the  shoe  is  easy  to 
understand,  each  branch  being  opened  by  the  play  of  the  screw 
which  passes  through  the  prolongation  of  the  median  piece,  one 
extremity  of  which  rests  upon  this  prolongation,  while  the  other 
presses  upon  the  inner  border  of  the  movable  branch. 

The  Goodwin  shoe  has  been  es- 
sentially improved  by  Foures  (Fig. 
510).  It  is  a  bar  shoe,  the  bar  being 
thicker  than  the  rest  of  the  shoe, 
and  wider  than  the  ordinary  bar 
shoe.  The  bar  is  notched  on  each 
side,  and  through  each  notch  runs 
a  thread  or  vise  which  holds  a  mov- 
able clip,  which  is  made  to  rest  on 
the  inside  of  the  bars,  and  which 
are  first  properly  thinned  out.  By 
a  motion  of  the  chp  through  the 
thread,  the  heels  are  slowly  dilated 
Fig.  510.— Foures'  Shoe.  by  degree.     This  shoe,  however,  is 

very  expensive,  difficult  to  make,  and  easily  put  out  of  order. 
In  all  these  methods  of  dilatation  the  shoe  has  to  be  made  of 
several  pieces,  and  in  this  condition  is  found  a  constant  cause  of 
weakness  and  of  rapid  deterioration,  for  which  reason  they  are 
not  very  practicable.  It  is  not  so  vdth  the  system  used  by  De- 
fays,  Sr.,  by  which  the  shoe,  besides  containing  the  essential  ele- 
ments of  the  desired  mechanical  dilatation,  is  left  entu'e  to  fulfill 
the  functions  of  the  ordinary  shoe,  as  well.  That  which  charac- 
terizes Defays'  method,  who  had  vised  it  in  1829,  but  which  was 
made  known  only  in  later  years,  is  that  the  shoe  itself,  which,  by 
its  ductihty  in  action,  becomes  the  agent  of  the  dilatation  of  the 
hoof,  becomes  also,  by  its  natural  tenacity,  the  obstacle  to  the 
return  of  the  foot  to  its  former  contracted  condition,  when  once 
it  has  yielded  to  the  outward  motion  which  it  has  acquired.     De- 


DISEASES.  661 

fays  uses  an  ordinary  shoe,  thick  and  narrow,  and  then  further 
narrowed  at  the  toe,  if  it  is  to  be  used  on  a  foot  regularly  con- 
tracted. When  it  is  thus  afi'ected,  at  five  or  six  centimetres  of  the 
heels  if  the  contraction  exists  at  the  quarters,  at  the  end  of  each 
branch.  This  shoe  carries  on  the  inside  border  a  strong,  resisting 
clip,  made  at  right  angles,  to  rest  on  the  internal  border  of  the 
wall  of  the  heels.  The  shoe  is  flat,  grooved,  like  an  English  shoe, 
with  nail-holes  slightly  turned  inward ;  the  last  nail-hole  made  as 
far  as  possible  from  the  heels.  It  is  made  of  the  best  quality  of 
ii'on,  in  order  to  resist,  when  cold,  the  greatest  amount  of  forced 
spreading  by  the  dilator ;  it  is  the  expansive  slipper  of  Defay's 
{'pantotifle  expansive). 

The  foot  upon  which  this  slijDper  is  to  be  fixed  must  have  both 
heels  pared  evenly,  the  sole  and  the  bars  pared  down  to  a  spring, 
and  the  hoof  round  the  frog,  on  each  side,  thinned  down  as  much 
as  can  be  borne.  Then,  the  shoe,  flattened  and  without  curvature 
on  its  faces — resting,  therefore,  on  a  strictly  horizontal  plane — is 
put  on  the  foot  in  such  a  manner  that  the  chp  of  the  heels  rests 
against  the  internal  face  of  the  quarters.  This  done,  the  space 
between  the  two  heels  is  measured  with  a  compass,  and  then  the 
dilator  is  applied  (Fig.  511).  This  instrument  represents  a  true 
vice,  with  jaws  reversed,  moving  from,  instead  of  apjDroaching 
each  other.  It  is  formed  of  two  jaws  which  can  be  made  to  ap- 
proach or  separate  by  a  transverse  screw  put  in  motion  by  a  mov- 
able lever.  The  degree  of  separation  is  regulated  by,  a  graduated 
rule  placed  horizontally,  which  serves  also  to  maintain  the  jaws  at 
the  same  point  when  separated.  The  two  jaws  being  introduced 
between  the  heels  of  the  shoe,  the  vice  being  held  perpendicularly 
to  the  plantar  face,  the  screw  is  slowly  turned  until  the  branches 
are  opened,  say,  eight  or  nine  millimetres ;  then  at  the  point  or 
points  of  the  shoe  which  have  yielded  to  the  pressure  of  the  in- 
strument, one  or  more  blows  are  struck  with  a  hammer  on  the 
outside  of  the  branch  of  the  shoe,  to  loosen  the  instrument,  until 
it  drops  down,  without  disturbing  the  screw,  a  record  being  made 
of  the  degree  of  dilatation  secured,  upon  the  graduated  register. 
After  three  or  four  days  the  same  operation  is  repeated,  the  spread- 
ing being  then  not  more  than  four  or  five  milhmetres.  It  must 
be  less  than  at  the  first,  because  at  the  beginning  the  less  perfect 
contact  between  the  projection  of  the  heels  of  the  shoe  and  the 
wall  has  allowed  a  considerable  amount  of  dilatation  without  pro- 


662 


OPERATIONS    ON    THE    FOOT. 


Fig.  511.— Def ays'  Contrary  Vise. 


ducing  much  result.  These  repeated  dilatations  once  in  four  days 
for  a  month,  are  assisted  by  the  apphcation  of  soft  poultices  in 
horses  which,  on  account  of  the  pain  and  consequent  lameness, 
are  kept  in  the  stable.  Others  may  be  j^ut  to  work,  and  receive 
poultices  only  when  at  rest,  or  may  be  turned  into  damp  fields. 
The  shoe  rarely  needs  changing  during  the  treatment,  which  lasts 
about  a  month.  This  mode  of  opening  the  heels  is  especially 
practicable  and  of  easy  application,  and  has  the  advantage  of 
allowing  the  use  of  the  horse,  whose  foot  is  as  well  protected  as 
with  the  ordinary  shoe.     It  becomes  indispensable  when  the  dis- 


G63 


ease  has  been  of  long  continuance,  and  is  accompanied  with  much 
lameness.  It  is  liable  to  but  one  contra-indication,  and  that  is 
when  the  foot  is  not  sufficiently  strong  to  hold  it,  by  reason  of  the 
heels  having  been  pared  down  excessively.  It  has  been  tested 
for  a  long  time,  not  only  by  the  Defays,  Senior  and  Junior,  but 
by  many  others.  H.  Bouley,  in  France,  with  Hartmann  and  Mayer 
in  Germany,  recommend  it  as  an  excellent  curative  treatment. 
These  instruments  have  been  modified  and  perfected,  such  as  those 
shown  in  Figs.  512  and  513. 


Pig.  512.— Defays'  Improved  Vise. 


Fig.  513.— Mericant'B  Desencasteleur. 


"We  must  again  mention  the  simple  and  light  desencasteleur  of 
Jovard  (Fig.  514),  which  is  as  powerful  as  that  of  Defays.  It  is 
composed  exclusively  of  a  double  vice,  with  opposite  threads, 
opening  or  closing  two  strong  claws,  which  are  applied  upon  the 


Fig.  514.— Jovard  Desencasteleur. 

internal  borders  of  the  branches  of  the  shoe ;  a  rod  of  iron  is  in- 
troduced in  the  holes  of  the  head  of  the  vice  and  puts  the  instru- 
ment in  motion. 

It  may  be  said  that  on  general  principles  it  is  preferable  to 
treat  hoof-bound  by  the  use  of  dilating  shoes  than  to  resort  to 
the  bloody  operations  recommended  in  earlier  times.     It  is  these 


664  OPERATIONS    ON    THE    FOOT. 

that  Brognie^;  recommended  highly  for  the  removal  of  one  or  two 
quarters  of  the  wall,  with  an  aj)propriate  dressing.  H.  Bouley, 
however,  believes  that  it  would  be  wrong  to  discard  these  opera- 
tions entirely;  he  believes  that  there  are  conditions  where  they 
become  necessary,  and  where  they  furnish  better  and  quicker 
results  than  the  others  referred  to. 

We  cannot  overlook  the  treatment  recommended  by  Barthelemy, 
which  consists  in  the  thinning  first  with  the  rasj),  then  with  the 
drawing  knife,  of  the  bars,  in  their  whole  length,  depth  and  thick- 
ness; thinning  them  down  to  a  spring  under  the  pressure  of  the 
finger.  This  done,  a  layer  of  blister  is  applied  on  the  skin  of  the 
cuti  dura  and  upon  it,  in  the  parts  corresponding  where  the  hoof 
has  been  thinned  down;  the  appHcation  to  be  renewed  several 
times,  until  the  lameness  has  subsided.  This  operation  is  followed 
by  an  excess  of  the  horny  secretion  and  a  marked  enlargement  of 
the  hoof,  and  gives  good  but  slow  results.  Gross  has  often  oper- 
ated in  the  same  manner,  alternating  the  blister  with  poultices. 

A  modus  operandi  which  has  also  been  very  satisfactory, 
is  the  one  that  was  recently  made  known  by  Weber,  and  which 
consists  in  the  division  of  the  wall  at  several  points,  by  grooves 
extending  down  to  the  keraphyllous  horn,  in  the  direction  of  the 
fibres  of  the  hoof.  Two  or  three  are  made,  on  each  side,  between 
the  quarters  and  the  heels,  the  heels  at  the  same  time  being  pared 
down,  when  a  bar  shoe  is  put  on  which  rests  on  the  frog,  or  if 
that  organ  is  atrophied,  pressure  upon  it  is  simulated  by  the  ad- 
dition of  pieces  of  leather.  Frequently,  instead  of  paring  the 
heels  down  excessively,  and  when  the  frog  is  atroj)hied,  we  prefer 
a  slipper  after  having  pared  the  sole  and  bars  to  a  spring.  The 
method  of  Weber  is  not  new.  It  was  previously  known  by  La- 
gueriniere,  and  is  mentioned  by  Brogniez  and  Hurtrel  d'Arboval. 
With  it  we  may  slowly  but  surely  achieve  success,  and  there  are 
but  few  feet  which  are  not  reheved  or  cured ;  but  the  grooves 
must  be  renewed  from  above  at  each  shoeing.  SoUej'sel  made 
lines  of  cauterization  on  each  side  of  the  heels,  extending  from 
the  hair  to  the  shoe,  which,  running  through  the  hoof,  softens  it 
and  renders  it  more  tractable. 

We  cannot  at  present  consider  the  comphcations  likely  to  be 
encountered,  but  must  satisfy  ourselves  by  remarking  that  in  cases 
of  false  c^uarters,  to  avoid  the  painful  pinching  of  the  soft  parts 
between  the  two  walls,  there  is  nothing  better  than  to  clean  the 


665 


place  of  separation  thoroughly  with  the  drawing  knife,  and  to  fill 
the  space  with  a  putty  of  gutta  percha. 

Diseases  of  the  Feog. 

This  part  of  the  horse's  foot  is  exposed  to  many  joathological 
lesions.  Some  are  merely  accidental,  and  result  from  the  intro- 
duction into  its  structure  of  nails,  and  other  various  foreign 
bodies,  more  or  less  sharp,  which  the  animal  picks  up  in  walking 
or  performing  his  work.  We  have  already  considered  these  forms 
of  lesion  in  the  article  upon  punctured  wounds.  The  frog  is 
often  bruised,  a  lesion  which  may  be  followed  by  a  comi^lication 
which  we  may  be  allowed  to  consider  under  the  name  of  furuncle 
of  the  frog.  But  besides  this,  some  special  diseases  are  also  ob- 
served, among  them  one  already  known  to  us  under  the  name  of 
canker^  and  another  which  is  more  commonly  known  under  that 
of  thrushes. 

(A)  Thkushes. — This  afi:ection  is  often,  but  wrongly,  considered 
as  the  beginning  of  canker,  being  characterized  by  the  presence 
of  a  puriform  secretion,  blackened  and  very  fretid,  which  collects 
and  accumulates  in  the  laciuise  and  excavations  of  the  frog, 
whether  in  its  middle  or  upon  its  sides.  There  is  often  an  in- 
creased sensibiUty  of  the  parts,  which  in  some  cases  may  give 
rise  to  very  serious  lameness,  preventing  the  animal  from  stand- 
ing, and  rendering  the  movement  of  walking  very  painful.  The 
horn  of  the  frog  often  becomes  soft  and  thready,  when  the  frog  is 
called  rotten.,  and  the  softness  increases  until  it  drops  off  by  piece- 
meal. 

The  causes  of  this  affection  are,  first,  excessive  work  on  stony 
roads ;  changes  from  excessive  dryness  to  moisture ;  the  strong 
muds  of  streets,  and  standing  in  damp  and  dirty  places,  esj)ecially 
in  urine  and  manure,  as  is  often  the  case  in  badly  kept  stables. 
But  there  are  horses  whose  feet  are  also  affected  with  thrushes 
even  when  standing  on  a  dry  bedding ;  those  whose  feet  are  con- 
tracted ;  and  again,  well-bred  horses  with  good  frogs,  and  in  which 
there  is  a  constitutional  tendency  to  that  condition  of  the  horny 
structiu'es. 

The  treatment  consists  in  avoiding  aU  known  causes  likely  to 
give  rise  to  this  morbid  condition  of  the  frog.  Sometimes  the 
foot  must  be  pared,  and  all  the  parts  where  the  puriform  secretion 


6C6  OPERATIONS    ON    THE    FOOT 

collects  exposed  and  thoroughly  cleansed.  The  lacunae  of  the  frog 
are  then  to  be  dressed  with  Villate's  solution,  ^gyptiacum  oint- 
ment and  sometimes  only  with  simple  drying  powders,  a  mixture 
of  subacetate  of  copper,  burnt  alum  and  tannin.  When  the  paui 
is  excessive,  glycerine,  with  a  little  Goulard's  extract  or  per-chloride 
of  iron,  is  very  beneficial.  Dusting  with  calomel  powder  gives 
also  excellent  results.  In  some  cases  again,  excellent  results  are 
obtained  by  poulticing.  It  is  certain  that  proper  shoeing  must, 
in  many  instances,  be  of  great  advantage. 

(B)  Furuncle  of  the  Frog. — Under  this  name  is  understood 
the  partial  necrosis  of  that  portion  of  the  plantar  cushion  which 
is  situated  above  the  frog  proper,  from  a  biruise  of  that  part  of  the 
hoof.  Loiset  describes  it  under  the  name  of  plantar  Jibro-chon,- 
drltis,  connecting  it  with  quittor,  which  he  named,  lateral  Jibro- 
chondritis. 

Sym/ptoins. — There  is  nearly  always,  and  especially  at  the  out- 
set, a  severe  lameness,  the  greater  in  degree  as  the  mortification 
is  more  extended  and  more  deejily  situated,  "WTaile  standing, 
the  affected  leg  is  carried  forward,  resting  on  the  toe ;  the  heels 
are  raised,  and  the  fetlock  is  half  flexed.  In  action,  the  rest  is 
very  slight,  sometimes  quite  absent,  and  occurs  on  the  toe  only. 
As  the  disease  progresses,  and  the  necrosed  spot  develops  itself, 
the  animal  rests  his  foot  better,  and  the  lameness  diminishes. 

Upon  examination  of  the  foot  early  in  the  history  of  the  case, 
a  small  oj)ening  may  ordinarily  be  discovered,  either  on  the  body 
of  the  frog,  or  in  its  branches,  while  at  other  times  there  is  merely 
a  discharge  of  a  yellowish  serous  pus  of  a  strong  odor,  and  more 
abundant  in  quantity  than  wotdd  be  expected  from  the  size  of  the 
wound,  while  surrounding  it  the  hoof  is  loose  and  sometimes  ready 
to  drop  off.  If  the  disease  is  several  days  old  a  mass  of  dead 
tissues  is  ordinarily  found  partly  loose,  projecting  through  the 
opening  of  the  frog,  which  has  the  aspect  of  a  whitish  body, 
slightly  green,  soft,  loose  and  detached  among  the  surrounding 
tissues.  When  this  core  (boui'billon)  is  not  visible  it  may  some- 
times be  felt  with  the  finger  introduced  through  the  wound  in 
the  frog. 

If  there  is  no  lesion  of  the  frog  the  purulent  fluid  accumulates 
under  the  hoof,  raising  and  loosening  it  from  the  velvety  tissues 
to  a  varying  extent. 

Fluctuations  may  be  sometimes  even  felt  under  the  hoof.  Some- 


DISEASES.  667 

time  the  j)us  oozes  through  the  lacunoe  of  the  frog,  while  again  it 
may  then  aj^pear  at  the  heels,  after  making  its  way  under  the  en- 
tire sole. 

Pathological  Anatomy. — As  we  said  at  the  beginning,  the 
characteristic  lesion  of  the  frog  is  the  gangrene  of  a  portion  of 
the  fibrous  structure  of  the  plantar  cushion,  when  it  changes  its 
general  aj)pearance  and  becomes  of  livid  yellow-greenish  color, 
while  at  the  same  time  a  process  of  elimination  takes  place  in  the 
surroimding  parts,  and  pas  forms,  separating  the  dead  tissues 
from  the  healthy  structure  surrounding.  This  process  of  elimina- 
tion is  more  active  on  the  surface  than  in  the  deeper  parts  of  the 
plantar  cushion,  to  which  very  often  this  core  remains  attached. 
In  some  serious  cases  the  disease  becomes  complicated  with  ne- 
crosis of  the  jDlantar  aponeurosis,  or  of  the  os  pedis,  and  some- 
times of  caries  of  the  lateral  cartilages,  or  cartilaginous  quittor. 

Causes. — Furuncle  of  the  frog  always  proceeds  from  some  vio- 
lent injury  through  the  horny  envelope  of  the  tissues  it  covers, 
either  when  the  hoof  has  been  cut  through  and  through  by  a 
sharp  instrument,  or  as  the  result  of  some  simple  bruise  with- 
out solution  of  continuity,  contusion,  or  even  crushing.  Any  for- 
eign body  likely  to  produce  a  punctui-ed  wound  of  the  foot  may 
produce  it.  But  in  such  cases  as  are  accompanied  by  furuncle  it 
is  necessary  that  the  wound  should  be  more  of  a  contused  or 
bruised  than  of  the  punctured  variety.  Kough,  angular  stones 
are  the  most  common  agents  of  injury,  being  often  picked  up  be- 
tween the  shoe  and  the  frog,  and  then,  pressing  more  or  less  upon 
the  tissues  underneath,  they  produce  the  same  result  when  they 
are  located  in  laminae  of  the  frog. 

A  thick,  voluminous  frog  in  a  foot  with  low  heels  is  very  much 
exposed  to  the  class  of  injuries  under  discussion,  equally  with  the 
frog  whose  horny  covering  has  been  pared  too  closely. 

Treatment. — The  first  indication,  says  H.  Bouley,  when  one 
has  to  treat  a  furuncle  of  the  frog,  is  to  thin  down  as  much  as 
possible  the  horn  of  the  plantar  region,  and  especially  that  of  the 
frog,  of  the  bars  and  the  branches  of  the  sole,  in  order  to  avoid 
the  painful  pressure  it  would  produce  if  its  thickness  should  in- 
terfere with  the  expansion  of  the  parts.  This  done,  if  the  frog  is 
already  punctured,  and  there  is  an  opening  communicating  Avith 
the  cavity  where  the  core  (or  boitrbillon)  exists,  a  free  incision  or 
opening  must  be  made  through  the  hoof  and  the  fibrous  covering 


668 


OPERATIONS    ON    THE    FOOT. 


of  the  plantar  cushion,  and  thus  the  escape  of  the  pus  facilitated. 
If  the  horny  frog  has  remained  intact,  a  longitudinal  incision  must 
also  be  made  in  order  to  allow  the  frog  to  discharge,  and  avoid 
further  burrowing  or  undermining  of  the  hoof.  It  is  bad  practice 
to  attempt  to  pull  the  core  out  with  a  sharp  instrument.  It  is 
better  to  leave  it  rmdisturbed  and  wait  for  the  natural  process  of 
elimination,  which  may,  however,  be  hastened  by  the  application 
of  a  poultice.  The  time  requu-ed  for  the  entire  separation  of  the 
necrosed  spot  varies,  and  as  it  approaches,  the  animal  begins  to 
imj)rove  in  the  matter  of  resting  his  foot.  When  it  becomes  en- 
tirely detached,  the  cavity  which  it  occupied  in  the  plantar  cushion 
is  treated  as  a  simple  wound,  with  turj)entine  or  tincture  of  aloes. 
However,  a  dressing  supported  by  the  shoe  with  plates  is  always 
advantageous,  and  must  be  frequently  repeated.  No  great  length 
of  time  is  usually  required  for  the  entire  healing  of  the  parts,  and 
the  animal  is  soon  returned  to  his  work. 

In  a  few  cases,  nevertheless,  the  furuncle  becomes  compHcated 
with  necrosis  of  the  plantar  cushion,  disease  of  the  os  pedis,  or  of 
the  lateral  cartilages,  the  treatment  of  which  must  vary  according 
to  the  nature  and  severity  of  the  lesions.  In  these  instances 
operations  similar  to  those  required  in  cases  of  deep  punctiired 
wounds  of  the  foot  or  in  cartilaginous  quittor  are  indicated. 

Keeaphyllocele. 

This  name  was  given  by  Yatel  to  a  tumor  which  forms  on  the 
internal  surface  of  the  wall  of  the  horse's  foot,  at  the  expense  of 
the  keraphyllous  tissue,  which  becomes  hypertrophied.  These 
tumors  are  sometimes  irregularly  rounded,  at  other  elongated, 
but  usually  rounded  and  again  flattened  from  side  to  side.  They 
vary  in  size  from  that  of  a  goose  quill  to  that  of  the  finger,  and 
while  in  some  cases  they  occujDy  the  whole  length  of  the  wall  from 
the  coronary  band  to  the  plantar  border,  in  others  they  only  begin 
at  one-third  or  one-half  of  the  height  of  the  wall.  The  difference 
in  size  allows  a  division  of  keraphyllocele  into  complete  and 
hiGomiylete.  At  different  points  the  columns  are  roughened  by 
frequent  enlargements.  Sometimes  full  and  formed  by  a  very- 
compact  and  hard  tissue,  they  are,  however,  sometimes  of  a  fis- 
tulous character  and  accompanied  by  a  blackish  discharge  of  an 
offensive  odor.  The  lamellae  of  the  reticular  tissue  which  are 
nearest  to  them  are  generally  wider  and  thicker  than  in  the  nor- 


DISEASES.  669 

mal  state.  As  the  tumor  increases  it  compresses  the  lamellated 
tissue  and  the  corresponding  surface  of  the  os  pedis,  injuring  the 
soft  parts,  and  resting  in  a  groove  they  thus  form  for  their 
development. 

The  causes  vt^hich  give  rise  to  their  development  are  more 
especially  cracks  of  the  walls ;  though  they  often  follow  laminitis 
or  supervene  upon  severe  operations  on  the  wall.  Vatel  claims 
to  have  observed  them  after  injuries  on  the  hoof  resulting  from 
the  hammering  of  the  foot  while  bemg  shod. 

The  symptoms  are  very  obscure.  At  first  the  animal  is  but 
slightly  sore  in  traveling,  but  the  lameness  increases  as  the  tumor 
enlarges  in  size.  The  region  surrounding  the  tumor  is  always 
warmer  and  more  sensitive  than  is  natural.  In  many  horses  the 
coronet  presents  a  swelling,  well  marked.  In  some  cases  the  dis- 
eased quarter  is  depressed,  and  the  toe  seems  elongated.  When 
a  toe  or  quarter  crack  is  accomjpanied  with  severe  lameness  kera- 
phyllocele  may  generally  be  suspected.  But  when  none  of  these 
external  signs  exists  it  is  exceedingly  difficult  to  make  a  positive 
diagnosis  of  their  presence,  for  though  the  swelling  of  the  coro- 
net, the  heat  and  the  pain  of  the  hoof  may  be  present,  those 
symptoms  may  belong  also  to  other  diseases  of  the  foot.  Then 
the  only  means  at  our  disposal  is  to  pare  the  foot  well  down, 
when,  at  the  surface  of  the  sole,  the  extremity  of  a  portion  of  hoof 
ordinarily  harder  than  the  normal  consistency  may  be  detected. 

The  treatment  consists  in  removing  the  portion  of  the  hoof 
corresponding  to  the  horny  tumor,  as  in  a  case  of  toe  cracks,  and 
treating  the  wound  thus  made  in  the  same  manner,  according  to 
the  indications  presented. 

Laminitis. 

Synonyms:  Sehe,  Versehlag,  Hufentzunclmtg,  German;  Four- 
bure,  Fourhature,  French ;  Rlfondhnento,  ItaHan ;  Aguadura, 
Spanish. 

By  this  name  is  understood  the  bloody  congestions  of  the 
keratogenous  apparatus  of  ungulated  animals.  The  increase  of 
the  circulating  fluid  produces  a  swelling  of  the  living  tissues  of 
the  foot ;  but  these  being  enclosed  in  a  box  of  so  hard,  resisting 
a  material,  a  painful  pressure  results,  which  becomes  especially 
common  and  serious  in  horses  and  other  solipeds.  It  has  also 
been  observed  in  bovines,  though  it  is  then  less  frequent  and 


670  OPEEATIONS    ON    THE    FOOT. 

serious.  It  has  also  been  seen  in  sheep,  in  goats  and  in  swine. 
It  may,  in  fact,  occur  in  all  ungulated  animals.  Dogs,  even,  are 
not  exempt  from  its  attacks. 

The  simjDle  bloody  congestion,  more  or  less  inflammatory,  of 
the  keratogenous  apparatus  of  the  horse,  is  sometimes  called  acute 
laminitis  and  acute  founder.  The  disease  may  pass  off  by  reso- 
lution, leaving  no  traces  of  its  occurrence,  but  more  commonly 
it  becomes  complicated  with  some  lesion  of  more  important  and 
serious  a  character,  as  hemorrhage,  suppuration,  inflammatory 
exudation,  and  especially  of  a  hypersecretion  of  the  horny  sub- 
stances, in  which  case  it  becomes  chronic  laminitis  or  founder; 
an  affection  which  gives  rise  to  alterations  of  a  jDeculiar  nature, 
and  leads  to  certain  changes  in  the  form  and  character  of  the 
hoof.  "We  do  not  agree  to  the  divisions  admitted  by  several 
authors,  into  traumatic  laminitis,  rheumatismal  lam,initis,  and 
metastatic  laminitis. 

I.  Symptoms. — Laminitis,  in  most  instances,  is  preceded  by 
certain  general  symptoms,  such  as  are  premonitory  of  the  inva- 
sions of  ordinary  inflammatory  diseases,  but  of  an  uncertain  sig- 
nificance. There  is  dullness,  general  insensibility,  muscular 
tremblings,  and  stiffness  of  the  loins.  The  respiration  is  accel- 
erated, the  pulse  febrile,  the  mucous  membranes  injected,  the 
mouth  dry,  the  f cecal  discharges  dry  and  coated,  the  urine  scanty; 
and  perhaps  anorexia  is  present.  Kodet,  who  held  that  laminitis 
is  more  a  secondary  than  primitive  affection,  and  that  it  is  simj)ly 
an  inflammatory  angeiothenical  fever  which  had  localized  itself, 
was  obliged  to  acknowledge  that  this  fever  has  nothing  character- 
istic, and  that  it  is  always  followed  by  laminitis. 

It  is  certain,  however,  that  but  a  short  time  elapses — from 
several  hours  to  one  or  two  days — after  the  originating  cause  has 
become  active,  before  the  bloody  congestion  of  the  reticular 
tissues  and  the  peculiar  phenomena  belonging  to  the  disease 
become  manifest.  It  is  only  when  the  capillary  circulation  of 
the  foot  has  considerably  increased,  and  when  the  rigidity  of  the 
structure  prevents  the  swelling  of  the  podophyllous  tissue,  that 
laminitis  truly  exists. 

Laminitis  in  the  horse  has  the  following  principal  symptoms : 
Considerable  heat  of  the  entire  foot,  extreme  sensibility  with 
intense  pain,  increasing  rapidly,  and  obliging  the  animal  to  rest 
upon  the  sound  legs,  in  order  to  relieve  the  affected  ones;  diffi- 


DISEASES.  671 

culty  and  uncertainty  in  walking ;  and  sometimes  a  peculiar  trem- 
bling of  the  muscles  of  the  patellar  face  of  the  femur,  and  of 
those  of  the  extensors  of  the  fore  arm,  which  fill  the  triangular 
space  formed  by  the  scapula  and  the  humerus.  The  physiognomy 
always  indicates  intense  suffering.  The  pulse  is  hard,  the  respi- 
ration increased,  and  the  skin  hot,  and  in  places  moistened  by  a 
copious  perspiration.  These  symptoms  vary  with  the  legs  which 
are  affected,  whether  the  disease  is  located  in  the  fore  or  hind 
feet  exclusively,  or  in  all  four  together.  As  M.  Bouley  says,  it  is 
a  peculiarity  of  this  affection  that  it  may  remain  localized  in  the 
feet  of  one  patient,  either  forward  or  behind,  ^  or  may  at  once 
attack  the  four  extremities,  and  that  it  seldom  attacks  the  limbs 
on  one  side  only,  to  the  exclusion  of  the  feet  of  the  opposite  side, 
i.  e.,  it  may  be  laterally  biped,  affecting  either  both  the  fore  or 
both  the  hind  feet,  but  not  often  occurring  othei'wise.  Some- 
times, however,  the  disease  is  more  marked  in  one  leg  than  in  the 
other  of  one  biped.  It  is  generally  only  after  some  traumatic 
lesion,  or  other  local  influence,  that  laminitis  occurs  in  one  foot 
only. 

When  laminitis  affects  the  two  anterior  feet,  the  animal  carries 
its  extremities  forward,  and  the  hind  feet  are  brought  well  under 
the  centre  of  gravity.  The  standing  of  the  animal  is  altered,  the 
walking  difficult  and  painful,  and  the  resting  of  the  feet  on  the 
ground  is  done  with  hesitation  and  fear.  The  feet  are  carried 
forward,  because  the  pressure  takes  place  on  the  frog  and  on  the 
heels ;  if  it  should  occur  as  in  the  healthy  and  normal  condition, 
upon  the  entire  inferior  circumference  of  the  foot,  there  would  be 
pressure  upon  all  the  living  tissues,  which  are  gorged  with  blood, 
tumefied  and  painful,  and  this  pressure  would  greatly  increase 
the  suffering  of  the  patient.  It  is,  then,  to  relieve  himself,  and 
to  avoid  the  intensity  of  the  pain,  that  the  animal  instinctively 
changes  its  mode  of  resting  on  the  ground.  In  placing  the  heels 
down,  the  weight  is  borne  only  upon  a  follicu.lar,  fatty  tissue ; 
from  there  it  spreads  along  the  side  of  the  coronet  to  the  fetlock, 
and  thus  upon  all  the  other  portions  of  the  leg,  and  in  this  way 
the  foot  becomes  greatly  relieved  during  the  action  of  resting. 
If,  however,  the  fore  legs  only  were  carried  forward,  the  effect 
would  be  equivalent  to  lengthening  the  body  of  the  animal,  and 
he  would  be  unable  to  carry  on  the  action  of  walking.  To  allow 
the  fore  feet  to  be  moved,  it  is  necessary  that  the  body  be  carried 


672  OPEEATIONS    ON    THE    FOOT. 

forward  by  the  hind  legs  and  brought  closer  under  the  centre  of 
gravity,  a  position  which  contributes  also  to  the  rehef  of  the 
animal  while  at  rest. 

The  more  painful  and  diseased  the  feet  become,  the  more  the 
animal  fears  the  impingement  of  the  ground.  Thus,  so  to  speak, 
he  sounds  the  ground  before  putting  the  foot  down,  and  for  this 
reason  the  walking  becomes  slow,  stiff  and  difficult,  and  the  noise 
of  the  contact  of  the  foot  louder  than  that  of  the  healthy  legs. 
Sometimes  the  animal  proceeds  only  by  a  series  of  jumps,  or  a 
kind  of  rearing,  while  backing  is  especially  difficult. 

The  hoofs  of  the  foundered  feet  give  to  the  hand,  when  feeling 
them,  a  sensation  of  heat  greater  than  that  in  the  physiological 
condition ;  a  sensation  which  can  be  more  readily  detected  by  a 
comparison  of  the  fore  and  hind  feet  simultaneously  examined. 
The  jjains  in  the  diseased  feet  are  rendered  more  manifest,  also, 
by  percussion  vipon  the  hoof  with  the  hammer,  when  each  blow, 
however  light,  is  followed  by  a  motion  of  the  animal  in  suddenly 
withdrawing  his  foot  on  account  of  the  pain  experienced.  The 
lateral  arteries  of  the  fetlock,  in  the  foundered  legs,  beat  stronger 
than  in  health,  and  can  be  readily  felt  by  the  fingers.  The  feet 
cannot  be  raised  without  great  effort,  and  when  raised,  the  animal 
stands  only  with  great  difficixlty,  and  makes  struggling  attempts 
to  relieve  himself  and  resume  its  natural  mode  of  standing  on 
fom'  legs. 

When  laminitis  affects  only  the  fore  feet,  the  animal  will 
sometimes  remain  standing  for  a  length  of  time  together;  he  may 
retain  this  attitude  for  several  days,  without  any  displacement  of 
his  body ;  still  he  is  observed  moving  surplace,  from  side  to  side, 
especially  on  his  fore  legs,  reheving  one  foot  for  a  moment  to  give 
the  same  comfort  immediately  afterward  to  the  other.  But  when, 
exhausted  by  fatigue  and  pain,  the  foundered  horse  lies  down,  it 
is  very  difficult  to  get  him  on  his  feet  again.  He  continues  in  the 
decubital  position,  l}Tng  mostly  flat  upon  his  side,  the  fore  legs  in 
constant  motion,  and  soon  complicates  his  diseased  condition  by 
the  addition  of  bed  sores  upon  the  prominent  parts  of  his  body. 

The  attitude  of  the  animal  is  very  different  when  the  hind  feet 
are  affected;  then  both  the  anterior  and  posterior  bipeds  are 
brought  to  each  other,  the  feet  of  the  hind  legs  being  carried  for- 
ward under  the  abdomen,  so  that  the  rest  may  take  place  upon 
the  heels ;  and  the  anterior  ones  are  carried  backward,  and  nearer 


DISEASES.  073 

to  the  centre  of  gTa\ity,  to  assist  the  function  of  the  hinder  ex- 
tremities in  sustaining  the  weight  of  the  body.  In  this  case,  the 
animal  is  constantly  in  side  motion,  on  account  of  the  pain  he  en- 
dures Walking  is  still  more  difficult,  and  seems  to  take  place  as 
if  the  animal  was  treading  on  sharp  needles,  as,  the  more  the  an- 
terior biped  is  engaged  under  the  body,  the  more  also  those  legs 
are  loaded  with  the  animal's  weight,  and  the  more  difficult  is  theu' 
movement.  But  the  anterior  legs,  contrary  to  their  ordinary  func- 
tion (not  being  adapted  to  the  support  of  an  overshare  of  the 
body)  sustaining  now  a  great  part  of  its  mass,  and  moreover, 
comj)elled  to  assist  in  the  act  of  propulsion,  necessarily  and  in- 
evitably become  easily  fatigued,  and  too  often  in  their  turn  be- 
come likewise  affected.  Animals  suffering  with  posterior  laminitis 
are  found  occupying  the  standing  position  less  freqviently  than 
those  whose  fore  feet  are  affected.  Their  unsteady  equilibrium, 
consequent  on  their  mode  of  standing,  tii'es  them  more  quickly, 
and  compels  them  to  lie  down,  and  once  on  the  ground,  it  is  again 
more  difficult  to  make  them  rise.  They  may  do  so  readily  with 
the  fore  legs,  but  the  posterior  extremities  do  not  always  respond 
to  the  call. 

The  attitude  of  animals  suffering  with  laminitis  of  all  the  four 
feet,  is  the  same  as  of  those  which  are  affected  in  the  fore  feet 
only.  All  four  feet  are  carried  in  advance  of  their  plumb  line,  the 
anterior  forward,  the  posterior  well  under  the  centre  of  gravity. 
Sometimes  the  horse  has  all  his  feet  somewhat  apart,  in  order  to 
carry  the  principal  part  of  the  weight  on  the  inner  side  of  the 
foot.  The  standing  posture  being  painfvil  to  either  foot,  the 
animal  lies  down  most  of  the  time.  Locomotion  is  very  difficult 
and  staggering,  and  the  animal  can  only  be  induced  to  move  by 
severe  punishment,  and  even  that  cruel  resort  sometimes  fails  to 
effect  it.  If  the  animal  is  made  to  walk,  he  does  it  with  the  great- 
est difficulty,  by  reason  of  the  increase  of  his  sufferings,  brought 
on  by  the  displacement.  His  legs,  stiff  and  trembling,  are  raised 
in  a  convulsive  manner,  and  brought  back  to  the  ground  with  the 
greatest  hesitation,  and  upon  the  heels ;  the  constant  motion  of 
the  lips  of  the  animal  being  well  characteristic  of  his  sufferings. 

In  the  ox,  laminitis  is  more  frequent  in  the  hind  than  in  the 
fore  feet.  It  is,  however,  more  serious  in  the  latter,  the  inner 
being  more  affected  than  the  outer  toe.  The  foundered  ox  walks 
with  hesitation,  and  takes  advantage  of  every  opportunity  to  lie 


674  OPERATIONS    ON    THE    FOOT. 

down.  'WTien  standing,  his  back  is  arched,  the  feet  closed  to- 
gether, the  hind  feet  resting  on  the  heels,  the  fore  legs  on  the 
points  of  the  toes.  The  fever  is  severe,  sometimes  attended  with 
loss  of  appetite  and  of  rumination.  If  the  disease  continues  long, 
the  cattle  will  die.  The  abdomen  is  stuck  up  and  the  animal 
loses  flesh  very  rapidly,  indicating  a  serious  condition,  as  the  dis- 
ease is  princij)ally  found  in  fat  animals,  which  are  obliged  to 
make  forced  marches  to  be  delivered  at  their  markets. 

II. —  Termination  and  Complications. — Well  treated,  laminitis 
is  generally  of  short  duration,  and  ends  in  three  or  four  days  by 
resolution.  Sometimes,  however,  this  is  not  accomplished  until  a 
later  period,  even  toward  the  tenth  day,  though  cases  of  this  charac- 
ter are  rare ;  and  even  when  resolution  proceeds  slowly,  some  lesions 
in  the  foot  may  be  looked  for,  and  chronic  laminitis  will  probably 
result.  Eesolution  in  acute  founder  is  marked  by  the  gradual 
disappearance  of  the  local  and  general  symptoms.  In  some  sub- 
jects, the  improvement  is  quite  rapid  from  day  to  day,  and  the 
form  of  termination  is  known  as  delitescency.  Laminitis  ending 
in  resolution  is  not  usually  followed  by  alterations  in  the  horny 
box  or  the  tissues  which  it  covers. 

When  the  congestion  which  constitutes  the  disease  terminates 
otherwise  than  by  resolution,  it  is  always  followed  by  accidents  of 
varying  character.  Some  of  these  may  have  a  happy  termination, 
but,  in  the  end,  are  more  or  less  likely  to  be  followed  by  a  de- 
formity of  the  horny  box,  to  which  the  name  of  chronic  laminitis 
is  given.  Before  entering  upon  this,  however,  let  us  examine  the 
various  complications  which  may  follow  acute  founder,  and  study 
in  succession:  the  hemorrhage,  inflammation  with  exudation, 
suji2')uration,  gangrene,  consecAitive  arthritis,  metastasis,  and, 
lastly,  chronic  laminitis.  Resolution  is  most  commonly  met  with 
in  the  ox.  Sometimes  the  separation  of  the  hoof  by  suppuration 
occurs,  and  chronic  founder  is  not  observed  in  that  animal.  It  is 
seldom  that  seedy  toe  is  observed. 

a. — Hemorrhage,  or  apox)lexy  of  the  reticular  tissue,  is  due  to 
the  rupture  of  the  excessively  distended  capillaries,  when  the  ex- 
travasated  blood  either  infiltrates  into  the  meshes  of  congested 
tissue,  or  spreads  around  it,  and  penetrates  between  the  podophyl- 
lous  and  keraphyllous  lamellae,  filling  up  the  spaces  at  the  toe,  the 
mammse  and  the  anterior  parts  of  the  quarters,  the  os  pedis  being 
pushed  back  by  the  joressure  of  the  incompressible  fluid.     The 


DISEASES.  675 

pain  is  then  very  great ;  tlie  blood,  continuing  to  separate  the  tis- 
sues, often  oozes  at  the  coronary  band. 

If  this  last  sign  is  absent,  a  groove  may  be  made  with  a  draw- 
ing-knife in  the  region  of  the  toe,  behind  the  commissure  of  the 
sole  and  of  the  wall.  If  we  meet  with  a  cavity,  resulting  from 
the  extravasation  of  the  blood  in  the  podophyU-ous  and  keraphyl- 
lous  space,  or  if  blood  flows  out  from  it,  the  true  nature  of  the 
comphcation  becomes  at  once  apparent.  This  mode  of  explora- 
tion is  generally  difficult,  as  the  animal  in  pain  does  not  readily 
allow  his  feet  to  be  raised,  and  as  the  other  foot  cannot  sustain 
the  entire  weight  of  the  body,  the  horse  easily  falls  down.  It  is 
sometimes  necessary  to  throw  the  animal  in  order  to  make  this 
exploration,  which  very  often  becomes  necessary  if  we  would  know 
accurately  the  progress  of  the  disease. 

h. — Inflammation,  with  fibrinous  exudation,  or  pseudo-mem- 
branous formation  on  the  surface  of  the  podophyllous  tissue. 
The  transudated  fibrine  mixes  with  the  hoof,  secreted  by  the  podo- 
phyllous tissue,  and  this  matter  separates  that  structure  from 
the  keraphyllous  laminae,  especially  at  the  anterior  part  of  the 
region.  Again,  in  chronic  laminitis  we  find  this  abnormal  secre- 
tion pushing  the  os  pedis  forcibly  backward  and  sej)arating  the 
toe  of  the  bone  from  that  of  the  hoof,  and  thus  producing  a  pain 
still  greater  and  more  violent  than  that  produced  by  the  laminitis 
and  the  hemorrhage.  These  pains  are  often  so  intense  that  they 
give  rise  to  an  access  of  furious  vertigo.  But  pains,  even  when 
of  an  exaggerated  degree,  indicate  simply  the  presence  of  the 
exudative  form  of  laminitis.  It  is  not  a  positive  sigh ;  the  foot 
must  be  explored  at  the  toe,  where,  in  the  vacuum  which  exists 
between  the  horny  lamellae  is  found,  more  or  less  abundantly,  a 
citrine  serosity  of  a  slightly  reddish  color.  Sometimes  this  ser- 
osity  oozes  between  the  hair  and  the  hoof,  in  consequence  of  the 
separation  of  the  tissues  at  the  coronary  band,  and  appears  in  the 
form  of  a  thin,  reddish  foam,  about  the  band  itself. 

c. — Suppuration  between  the  wall  and  the  podophyllous  tis- 
sue is  a  complication  more  rare  than  the  others,  but  which,  how- 
ever, has  been  observed,  especially  when  laminitis  is  traumatic. 
We  have  seen  it  appear  under  the  sole  and  separate  it  entirely 
from  the  tissues  underneath.  In  these  cases,  the  pain  is  always 
very  great,  and  the  living  structures  are  pressed  beyond  measure. 
Standing  is  impossible,  and  the  animal  continues  lying  down,  or, 


676  OPERATIOXS    ON    THE    FOOT. 

under  the  influence  of  the  pains,  constantly  moving  from  one  leg 
to  another,  balancing  himself,  so  to  speak.  There  is  no  relief  for 
him  until  the  suppuration  has  shown  itself  between  hair  and  hoof, 
when  it  oozes  outward  at  the  coronet.  Relief,  however,  may  also  be 
obtained  by  making  an  opening  at  the  toe  with  the  drawing-knife. 
This  complication  often  results  in  the  entire  separation  and  drop- 
ping off  of  the  hoof.  Cases  have  been  observed  when  this  acci- 
dent has  taken  place  as  early  as  the  third  day  (Lafosse,  Stanley). 
Gillmeyer  has  seen  a  new  foot  grow  out  entirely,  but  this  requkes 
a  long  time. 

d, —  Gangrene  of  the  sub-horny  tissues  sometimes  takes  place, 
though  seldom,  under  the  influence  of  the  excessive  pressure, 
especially  when  there  is  sub-homy  exudation.  The  violent  pains 
then  cease  suddenly ;  the  resting  becomes  more  solid ;  the  move- 
ments take  j)lace  without  difficulty.  But  at  the  same  time,  the 
physiognomy  of  the  patient  becomes  anxious  and  contracted;  the 
pulse  becomes  small  and  difficult  to  count ;  the  temperature  of  the 
body  diminishes ;  the  animal  has  a  trembling  gait ;  is  indifferent 
to  any  excitement ;  he  is  prostrated,  and  soon  he  ends  by  sep- 
ticaemia. The  hoof  then  often  drops  off,  and  the  sub-horny  tis- 
sues are  seen  to  be  of  a  bluish-brown  color,  without  consistency, 
but  with  a  very  foetid  odor. 

Volpi  thought  that  laminitis  was  the  inflammation  of  the  articu- 
lation of  the  foot ;  but  this  arthritis,  if  it  exists  (a  fact  which  is 
rare),  is  not  a  consecutive  phenomenon,  but  a  complication.  The 
inflammation  does  not  remain  limited  to  the  recticular  tissue ;  it 
extends  also,  and  consecutively,  to  the  contiguous  structure, 
spreads  to  the  tendons  and  articular  ligaments,  even  penetrates 
to  the  synovial  capsules  of  the  articulation  of  the  third  with  the 
second  phalanges,  and  may  also  react  upon  other  parts  of  the 
organism.  The  anchylosis  of  the  articulation  of  the  foot  with 
that  of  the  coronary  joint  are  complications  somewhat  frequent, 
as  well  as  that  of  the  ossification  of  the  cartilages  of  the  foot. 

e.  —  Metastasis  has  been  often  observed,  and  when  accom- 
panied by  intense  fever  have  been  noticed  as  complicated  with 
serious  diseases  of  the  chest,  especially  of  pleuro-pneumonia.  At 
other  times,  it  has  been  the  intestines  to  which  the  metastasis  has 
transferred  the  disease,  in  which  case  there  is,  in  most  instances, 
constipation  of  the  bowels.  Enteritis,  however,  is  seldom  ob- 
served, notwithstanding  what  has  l^een  said  on  the  subject.     This 


DISEASES.  677 

metastasis  has  also  been  seen  toward  the  lumbar  region,  and  this 
is  much  more  commonly  believed  from  the  fact  that  there  is  more 
motion  at  the  hip  than  at  any  other  joint  during  locomotion,  and 
also  because  the  back  and  the  loins  are  more  or  less  arched.  In 
fact,  laminitis  has  been,  by  some,  designated  as  an  affection  of  the 
loins ;  some  have  looked  upon  it  as  a  rheumatism  of  that  region. 
All  these  errors  have  originated  in  the  peculiar  motion  of  the  ani- 
mal while  walking,  or  of  its  peculiar  mode  of  resting  when  stand- 
ing still.  We  have  also  observed  an  attack  af  complete  myelitis 
as  a  complication  of  laminitis. 

/. — The  most  common  complication  met  with  in  chronic  lam- 
initis is  an  affection  which  we  might  have  treated  as  a  special  sub- 
ject had  we  not,  upon  principle,  considered  it  as  a  sub-inflamma- 
tory state  of  acute  founder  of  the  foot.  An  attack  of  laminitis 
which  has  not  ended  by  resolution  in  five,  ten,  or  fifteen  days  at 
most,  takes  a  character  of  persistency  which,  in  most  cases,  ends 
in  absolute  incurability.  To  properly  study  chronic  laminitis  we 
must  observe  it  when  the  alterations  which  characterize  it  are  ac- 
complished. When  we  have  completed  the  consideration  of  the 
pathological  changes,  we  will  examine  the  intermediate  period, 
and  discuss  the  mechanism  by  w-hich  these  alterations  take  ]3lace 
in  relation  to  the  pathological  anatomy. 

The  first  thing  observed  is  the 
change  of  form  in  the  hoof  (Fig. 
515).  The  nail  of  a  horse's  foot 
easily  recalls  the  form  of  a  Chinese 
shoe  (Knollhuf,  of  Germany).  The 
hoof  seems  to  have  also  lost  its 
varnish  and  its  suppleness  in  the 

•    ,  T  i.      J.1"       T  Fig.  515.— Chronic  Laminitis. 

pomts  correspondmg  to  the  dis- 
eased parts.  It  is,  besides,  brittle,  and  seems  to  have  lost  part 
of  its  connection  with  the  remaining  parts  of  the  foot,  and  there 
is  a  change  in  the  direction  of  the  wall,  the  fibres  of  which, 
instead  of  being  oblique  to  the  ground,  assume  an  almost  hori- 
zontal direction.  The  foot  seems  as  if  flattened  from  above  down- 
ward, and  the  lines  which  bound  its  surface  form  a  well-marked 
obtuse  angle  with  that  of  the  coronary  region.  The  anterior  wall 
of  the  foot  also  forms  a  well-marked  projection  forward,  from 
which  results  a  great  exaggeration  of  the  antero-posterior  diame- 
ter of  the  nail  with  the  ti'ansverse  diameter  and  the  oval  form  of 


678 


OPERATIONS    ON    THE    FOOT. 


the  horny  box.  The  external  surface  of  the  wall,  instead  of  be- 
ing smooth,  as  in  physiological  conditions,  presents,  on  the  con- 
trary', a  roughened  aj^jjearance,  which  results  from  the  presence 
of  circles  of  ridges  and  circular  grooves,  placed  one  above  the 
other  and  extending  from  one  heel  to  the  other.  A  remarkable 
peculiarity  is  here  observed  in  the  fact  that  in  the  anterior  part  of 
the  nail  the  circles  are  quite  near  each  other,  while,  on  the  con- 
irary,  upon  the  lateral  parts  they  are  separated  by  much  wider 
grooves.  "When,  then,  at  the  toe,  the  wall  has  some  difficulty  in 
growing  downward,  on  account,  probably,  of  the  internal  adhes- 
ions between  the  podophyllous  and  keraphyllous  tissues;  the 
heels,  on  the  contrary,  grow  without  difficulty,  and  thus  obtain  a 
relative  height  superior,  and  sometimes  even  equal,  to  that  of  the 
toe.  Often  at  the  mammae  and  quarters  of  the  foot  contractions 
are  seen,  and  longitudinal  grooves  running  from  the  coronary 
band  to  the  plantar  surface,  reminding  one  of  the  lesions  usually 

met  Avith  in  encastelure. 

Considered  on  the  side  of 
the  inferior  face,  the  old  f ound- 
dered  hoof  offers  four  remark- 
able lesions  (Fig.  516).  Besides 
its  oval  form,  a  disposition  al- 
together different  from  that  of 
the  normal  state,  the  sole  is 
convex  in  all  the  anterior  part 
of  the  plantar  region,  especially  at  the  point  of  the  frog.  There 
exists  at  that  point  a  transversal  tumor  or  enlargement,  projecting 
sufficiently  to  exceed  in  height  the  inferior  border  of  the  wall.  The 
solar  sheet  has  been  pushed  outward  by  the  pressure  against  the 
superior  face  from  the  contents  of  the  horny  box,  and  the  foot  is 
convex.  This  convexity  never  equals  the  entire  extent  of  the  foot, 
the  deformity  ending  at  the  boundary  of  the  inferior  border  of 
the  bars,  beyond  which  and  backward  are  found  the  cavities  of  the 


Fig.  516.— Chronic  Laminitls,  last  stage. 


also  higher  (Fig.  517).  The  center  of  this  tumor  or  enlargement 
of  the  sole  is  often  flexible  under  the  pressure  of  the  finger,  and 
generally  bleeds  easily  on  the  application  of  the  sharp  tools  of  the 
blacksmith.  It  is  not  rare  to  see  the  sole  perforated  through  and 
through  and  showing  the  inferior  border  of  the  os  pedis  project- 
ing through  the  border  of  the  bone,  which  then  soon  becomes 


679 


Fig.  517.— Foot  affected  with  Chronic  Laminitis. 

a.— Anterior  extensor  of  the  phalanges.  6.— Ordinary  wall,  c— Coronary  band. 
d.—Podophyllous  tissue  modified,  e.— Morbid  horny  wall.  /.—Seedy  toe.  jr.- Displaced 
and  deformed  OS  pedis,  ft.— Velvety  tissue.  1—Perforans  tendon.  7'.— Navicular  bone. 
A;.— Perforatus  tendon.    I  —Plantar  cushion. 

necrosed.  This  is  the  result  of  the  excessive  displacement  of  the 
OS  pedis  and  of  the  strong  pressure  upon  the  velvety  tissue  against 
the  sole-tissue,  which  is  atrophied  or  even  destroyed  (Fig.  518). 
This  is  an  ulcerating  wound,  somewhat  semi-lunar,  secreting  a 


Fig.  518.— Chronic  Laminitis,  with  Keraphylocele 


t)»U  OPERATIONS   ON    THE    FOOT. 

very  offensive  pus,  with  granulation  and  proud  flesh,  or  even  sepa- 
ration of  the  sole. 

Between  the  sole  and  wall  the  line  of  demarcation  is  no  longer 
so  well  defined  as  in  the  normal  state.  At  the  toe,  the  mammae 
and  the  anterior  part  of  the  quarter,  there  is  an  excavation  formed 
of  softer  horn  of  bad  nature,  and  less  identified  with  the  true 
horn  of  the  wall  and  of  the  sole.  A  complete  vacuity  is  often 
found,  a  cavity  around  the  internal  face  of  the  wall  at  the  toe  and 
at  the  mammae  of  varying  depth  and  size,  but  always  larger  at  the 
inferior  than  at  the  sujDerior  end  of  the  foot,  where  it  gradually 
diminishes,  and  often  contains  a  dry,  granular  mass,  resulting 
from  the  drying  of  the  blood,  and  the  di'ied  plastic  lymjjh,  mixed 
with  small,  horny,  pulverized  masses.  This  cavity  is  formed  in 
front  by  the  healthy  wall  and  posteriorly  by  a  new  wall  due  to 
the  secreted  hoof  thrown  upon  the  podophyllous  tissue ;  this  is 
called  seedy  toe.  This  double  wall  is  observed  especially  after 
laminitis  of  the  hind  feet ;  it  is  more  common  in  the  donkey  and 
the  mule ;  it  is  also  noticed  in  horses  with  small  feet,  as  in  those 
of  Oriental  breeds. 

The  deformities  of  the  horny  box  due  to  chronic  laminitis  are 
not  in  all  cases  identical  in  their  character;  there  are  degrees  in 
them,  and  consequently  they  vary  in  their  features,  which  varia- 
tions are  due  to  the  duration  of  the  disease  and  its  intensity,  and 
also,  according  to  H.  Bouley,  to  the  primitive  form  of  the  diseased 
foot.  In  a  case  of  chronic  founder  of  the  fore  feet,  one  may  often 
notice  a  difference  between  the  deformity  of  the  left  and  that  of 
the  right  foot.  The  deformities  may  take  place  at  various  times, 
and  one  may  find  a  well-marked  case  of  seedy  toe  while  as  yet 
the  wall  has  j)reserved  its  normal  oblique  direction  and  shown 
rudimentary  ramy  appearances.  Again,  the  wall  may  have  under- 
gone changes  in  its  direction  only  at  the  new  hoof,  which  grows 
from  the  coronary  band;  there  is  then  formed  between  the  old 
wall  and  the  coronet  a  cu'cular  groove,  sometimes  called  the  digi- 
tal cavity,  the  deformities  of  the  wall  taking  place  only  as  it  grows 
down.  At  times,  also,  instead  of  the  groove,  there  is  a  ridge  of 
horn  at  the  coronary  band,  originating  in  the  hyper-secretion  of 
the  horn,  which  grows  also  downward.  And,  again,  there  are 
cases  where  there  is  seedy  toe  and  still  no  well-marked  alteration 
of  the  shape  of  the  wall  of  the  sole. 

Chronic  laminitis  is  always  accompanied  with  more  or  less 


DISEASES.  G81 

lameness.  There  are  cases,  however,  where  it  is  missing ;  for  ex- 
ample, in  seedy  toe.  Ordinarily,  the  foot  is  raised  from  the  ground 
with  a  convulsive  motion,  as  may  be  well  observed  in  donkeys  and 
mules,  which  animals  rest  their  feet  on  the  heels.  This  soreness 
diminishes  with  time,  as  the  foot,  assuming  its  new  form,  offers  a 
wider  space  to  the  sub-ungulated  tissues  and  presses  less  upon 
them,  these  tissues  having,  at  the  same  time,  become  somewhat 
atrophied.  In  cases  of  hernia  of  the  os  pedis,  the  resting  of  the 
foot  on  the  ground  is  ahnost  impossible,  the  animal  being  afraid 
to  bear  his  weight  on  the  sole.  The  heat  and  the  pain  of  the  feet 
are  less  marked.  The  percussion  is  louder  in  case  of  seedy  toe, 
while  it  is  duller  when  the  space  between  the  wall  and  the  recticu- 
lar  structure  is  filled  with  hoof  of  new  formation.  This  percus- 
sion is  very  painful  in  case  of  keraphylocele.  Unless  there  are 
serious  lesions,  chronic  laminitis  is  not  accomjoanied  with  fever. 

III.  Pathological  Anatomy. — At  the  initial  period  of  lamini- 
tis, when  there  is  only  simple  congestion  of  the  keratogenous  ap- 
paratus, and  especially  of  the  podoph^ilous  tissue,  the  sub-horny 
tissues  are  in  a  condition  of  sanguineous  derangement,  characterized 
by  objective  signs.  "\^Tien  the  hoof  covering  them  during  life  is 
removed,  they  are  found  of  a  dark  red  color,  in  a  kind  of  eythema. 
When  pressed  between  the  fingers,  their  thickness  is  noted  to  be 
increased,  and  they  are  f  oimd  to  be  gorged  with  blood,  an  incision 
made  through  them  allowing  the  escape  of  a  large  quantity  of 
that  fluid. 

If  the  laminitis  exists  for  several  days,  the  podophyllous  tissue 
is  found  to  be  infiltrated  with  plastic  exudations,  and  if  there  has 
been  hemorrhage  or  apoj)lexy,-  blood  is  found  between  both  the 
sensitive  and  insensitive  laminae.  In  other  cases  there  is  pus,  and 
in  case  of  gangrene,  the  tissues  are  found  of  a  livid  color. 

The  alterations  are  still  more  serious  in  cases  of  chronic 
founder.  ^Tien  a  foot,  foundered  for  some  time,  is  divided  by 
the  saw  in  its  antero-posterior  axis  by  a  section  of  all  the  jDarts, 
the  thing  first  noticed  is  a  change  in  the  connection  of  the  os 
pedis  with  the  wall.  These  changes,  however,  exist  principally  at 
the  toe,  and  extend  as  far  as  the  half  of  the  quarters,  on  a  level 
with  the  lateral  cartilages  of  the  foot,  while  further  backward  they 
are  not  to  be  observed.  On  the  side,  some  laminae  are  always 
found  in  their  normal  condition,  as  can  be  seen  by  a  section  of 
the  foot  made  transversely.     Generally,  a  yellowish  substance,  of 


G82  OPERATIONS    ON    THE    FOOT., 

horny  appearance,  but  softer,  fills  uj)  the  si^ace  situated  between 
the  walls  and  the  keratogenous  structure.  This  is  the  product  of 
the  exudation  of  the  inflamed  podoj:»hyHous  laminae,  mixed  with 
the  horny  substance  which  they  secrete  normally.  These  laminae 
are  themselves  hypertrophied,  being  sometimes  one  and  two  cen- 
timeters in  length  and  exceeding  by  four  or  five  times  their  nor- 
mal size.  The  keraphyllous  laminae  are  also  hypertrophied,  a 
condition  which  is  evidently  due,  as  resj)ects  the  podophyllous 
tissue,  to  the  increase  of  vital  activity,  resulting  from  the  inflam- 
matory condition  of  the  tissue  and  to  the  infiltration  by  fibro- 
plastic exudation,  resulting  from  the  inflammation.  As  to  the 
keraphyllous  laminae,  they  rejDeat  on  the  internal  face  of  the  wall, 
in  an  inverse  manner,  the  disposition  of  the  secreting  laminae  of 
the  hoof  between  which  they  are  formed  and  lodged.  These, 
however,  as  they  increase  in  extent,  unite  at  their  base  in  the 
whole  of  that  portion  which  does  not  co-operate  to  theu'  union 
with  the  podophyllous  bands,  and  then  forms  a  compact  mass 
uniting  most  frequently  with  the  internal  face  of  the  wall.  Some- 
times this  mass  of  yellowish  hoof  occupies  the  whole  space  be- 
tween the  OS  pedis  and  the  wall,  but,  in  some  cases,  it  adheres 
only  to  the  wall,  when  it  forms  around  the  keratogenous  tissue,  a 
new  wall,  also  provided  with  keraphyllous  laminae,  and  there  is 
formed  between  it  and  the  normal  wall  that  porous,  brittle  mass, 
without  homogeneity,  which  fills  up  the  space,  which  constitutes 
the  seedy  toe.  The  mass  thrown  between  the  wall  and  the  os 
pedis  presses  upon  it ;  the  anterior  face  of  the  bone  assumes  a 
vertical  direction,  and  the  os  pedis  presses  toward  the  solar  arch 
on  its  anterior  border  at  a  point  situated  posterior  to  that  where, 
in  normal  feet,  this  border  rests.  Notwithstanding  its  resting 
power,  the  wall  gives  to  the  effort  of  the  mass  interjDosed  in  front, 
the  form  of  the  foot  changes,  and  then  results  the  change  to  the 
oval  in  the  contour  of  the  foot.  Under  the  influence  of  the  dis- 
placement of  the  phalanx,  not  only  the  flattening  and  afterward 
the  convexity  of  the  sole  and  even  its  perforation  results,  but  the 
plantar  cushion  is  itself  pressed  down  and  crushed  between  the 
bone  and  the  frog,  which  is  then  generally  atrophied.  A  hoof  of 
new  formation  is  often  developed  between  the  sole  and  the  infe- 
rior face  of  the  phalanx,  in  order  to  prevent  it  from  necessarily 
sinking.  This  increases  the  pressure  upon  the  bone  and  contrib- 
utes to  its  atrophy  and  sometimes  to  its  complete  disintegration. 


DISEASES.  683 

But,  between  the  surface  of  tlie  coronary  band  and  the  origin 
of  the  roof,  whose  formation  is  anterior  to  the  himinitis,  there 
may  also  be  a  new  layer  of  hoof,  more  resisting  than  that  which 
occupies  the  space  between  the  wall  and  the  podophyllous  tissue, 
which  is  no  more  hoof  mixed  with  the  fibrinous  exudation,  but  a 
pseudo-hoof  secreted  by  the  coronary  band.  The  fibres  of  this 
hoof,  however,  instead  of  being  rectilinear  and  growing  down  in 
the  direction  of  the  old  wall,  with  the  fibres  of  which  they  are 
continuous,  are,  on  the  contrary,  sinuous  and  nodulated,  and  dis- 
posed to  take  a  somewhat  horizontal  direction.  There  is  often, 
besides  the  old  wall,  a  deep  horny  tumor,  a  keraphyllocele  which 
grows  inside,  attempts  to  replace  the  soft  horn  secreted  by  the 
podophyllous  tissue,  and  adds  to  the  pressure  of  the  os  pedis,  by 
forming  a  new  wedge,  more  solid  and  resisting,  which  produces  a 
displacement  of  the  phalanx,  whose  anterior  face  then  often  be- 
comes more  than  vertical.  This  horny  secretion  from  the  coronary 
band  is  made  evident  by  a  section  of  a  foundered  foot,  when  the 
cutigeral  cavity  will  be  found  much  enlarged.  Guy  on,  Jr.,  Hert- 
wig,  and  Gourdon  remark  that  the  displacement  of  the  os  pedis  is 
counterbalanced  by  the  more  rapid  development  of  the  heels  and 
the  projection  of  the  foot  forward ;  and  that  thus  the  phalanx 
does  not  sui:)port  the  weight  of  the  body  except  by  its  inferior 
border  only,  but  preserving  nevertheless,  its  primitive  position. 
It  is  especially  observed  that  when  the  foot  is  completely  de- 
formed, the  projection  of  the  wall  does  not  prevent  the  os  pedis 
from  remaining  in  its  normal  position. 

The  growth  of  the  hoof  from  the  podophyllous  tissue  and  the 
coronary  band  is  not  easily  stppped.  The  horny  masses  which 
are  formed  continue  to  increase,  and  even  soon  end  in  uniting. 
There  then  remains  a  thick  mass  of  deformed  shape,  four  or  five 
times  thicker  than  the  normal  wall,  but  where  the  keraphyllous 
leaves  are  still  noticed,  corresponding  to  the  podophyllous  laminae, 
largely  developed,  and  above  all,  running  deeply  into  the  wall  of 
the  hoof.  The  space  between  the  wall  and  the  anterior  face  of 
the  OS  pedis  is  filled  with  pus  besides  the  secreted  hoof ;  the  seedy 
toe,  if  it  existed,  disappears.  Though  the  hoof  becomes  thus 
much  more  voluminous  than  before,  the  deep  parts  are  not  any 
more  in  their  normal  condition,  but  are  lodged  in  a  smaller  and 
smaller  sj^ace,  and  are  thus  in  such  a  state  of  compression  that 
they  become  atrophied.     The  bone  is  altered  in  its  texture,  as 


684 


OPEKATIONS    ON    THE   FOOT. 


Fig.  519.— Changes  of  Structure  of  the  Os  Pedis  in  old  cases  of  Chronic  Laminitla. 

well  as  in  its  form,  and  becomes  denser  and  more  brittle.  (Fig. 
6ld).  One  might  suppose  that  as  the  disease  progresses,  the  os 
pedis  would  become  pressed  backward  more  and  more  toward  the 
sole,  in  consequence  of  its  giving  way  under  the  pressure.  This, 
however,  is  not  so.  As  the  old  normal  walls  disappear,  the  new 
horn  yields  to  the  pressure  from  forward,  the  heels  rise,  the  os 
l^edis  resumes  its  horizontal  direction,  and  the  danger  of  hernia 
of  the  bone  diminishes,  and  a  hypersecretion  of  the  hoof  is  even 
noticed  toward  the  point  where  the  hernia  would  have  taken 
place,  in  the  middle  of  the  pumiced  sole. 

We  have,  so  far,  supj)Osed  that  chronic  laminitis  is  always 
manifested  by  the  presence,  between  the  internal  face  of  the  wall 
and  the  podophyllous  surface,  of  a  mass  of  abnormal  hoof.  But 
there  are  cases,  after  hemorrhage,  and  especially  after  serous 
exudation,  where,  instead  of  it,  a  cavity  is  found — a  seedy  toe. 
There  is  also  an  entire  separation  between  the  os  pedis  and  the 
wall.  But  the  horny  production,  that  of  the  podophj'llous  tissue 
especially,  is  not  sufficient  iu  amount  to  fill  up  the  whole  space, 
there  being  hoof  only  upon  the  podojDhyllous  tissue.  There  is 
then  a  sound  wall  formed,  separated  from  the  old  one  by  a  vac- 
uum, which  is  often  filled  by  a  dry  mass  derived  from  the  blood 
and  serosity,  mixed  with  the  horny  cells.     But  more  frequently 


DISEASES.  685 

the  separation  is  limited  to  the  height  of  the  poclophyllous  tissue, 
and  the  wall  yet  remains  adherent  to  the  coronary  band,  by  its 
cutigeral  cavity.  The  band  then  continues  to  produce  the  ex- 
ternal wall  of  the  hoof,  while  the  podophyllous  produces  the 
abnormal  waU,  and  the  seedy  toe  remains  between  the  two  walls. 

There  are  cases  where  the  separation,  produced  by  the  con- 
gestion of  laminitis,  takes  place  to  such  an  extent,  in  circumfer- 
ence or  in  height,  that  the  hoof  loses  all  its  adhesion,  except 
toward  the  heels ;  and  then  one  may  see  the  curious  fact  of  the 
new  generation  of  an  entire  new  nail  within  the  old  one,  the  for- 
mer being,  so  to  speak,  sequestered  in  the  latter. 

rV.  Differential  Diagnosis. — It  is  possible  that,  notwith- 
standing its  distinctly  characterized  physiognomy,  laminitis,  of 
the  hind  feet  especially,  may  be  mistaken  for  a  disease  of  the 
sj)inal  region.  Often,  when  the  founder  is  light,  the  hinder  parts 
wag,  as  in  sj)rains  of  the  loins,  but  the  resting  of  the  feet  on  the 
heels,  their  heat  and  their  sensibility,  will  soon  point  out  the  dis- 
tinction. In  more  severe  cases,  the  hinder  founder  may  stimu-. 
late  paralysis,  especially  if  the  animals  cannot  or  will  not  raise 
themselves.  Here  the  history  of  the  case  is  very  useful,  and  the 
explorations  of  the  feet  will  assist  in  making  the  diagnosis.  "We 
have  seen  cases  of  laminitis  behind,  where  the  raising  of  the  foot 
has  been  such  that  it  might  be  taken  for  springhalt,  or  even  for 
locomotor  ataxy.  It  may  be  also  taken  for  tetanus  when  in  mild 
form,  or  yet  incompletely  characterized. 

V.  I^rognosis. — Laminitis  is  so  much  more  alarming  and  re- 
bellious as  to  treatment,  as  it  is  more  extensive,  more  serious,  and 
of  longer  existence.  The  most  serious  cases  are  those  which  are 
due  to  a  constitutional  predisposition,  and  those  which  follow  a 
general  alteration,  or  are  complicated  with  other  diseases. 

Chronic  laminitis  is  especially  serious  from  the  production 
without  separation,  and  in  an  excessive  measure,  of  the  horny 
substance.  Seedy  toe  is  then  less  serious,  and  that  which  does 
not  extend  to  the  coronary  band  is  sometimes  curable  by  the 
gradual  growth  of  the  hoof;  the  tumor  of  the  os  pedis  is  the 
most  rebellious  to  treatment.  The  destruction  of  patients  is  often 
necessary,  from  then-  inability  to  walk  or  to  do  any  work,  and 
that  notwithstanding  all  treatment  they  are  entirely  useless. 

VI.  Etiology. — Laminitis  has  been  attributed  to  many  and 
the  most  varied  causes,  and,  among  others,  has  now  been  ascribed 


686  OPEKATIONS    ON    THE    FOOT. 

to  a  traumatic  origin,  consisting  of  injuries  of  the  foot ;  and  again, 
to  internal  lesions,  resulting  in  the  inflammatory  process  which  is 
characteristic  of  the  affection. 

The  external  traumatic  injuries,  which  it  is  claimed  are  those 
chiefly  instrumental,  are,  on  the  contrary,  of  very  rare  occurrence 
as  causes  of  the  disease.  Our  observations  agree  with  those  of 
H.  Bouley,  and  if  there  is  a  traumatic  causation  for  this  disease, 
or,  at  least,  one  identical  with  it  in  respect  to  symptoms  and 
primitive  lesions,  it  is,  nevertheless,  certain  that  its  progress  is 
very  different ;  there  is  found  with  it  an  evident  tendency  to  suj)- 
puration  instead  of  exudation,  and  there  is  no  such  formation  as 
the  chronic  process  which  is  found  when  laminitis  is  due  to  an 
internal  phlegmasia. 

It  has  been  said  in  reference  to  the  action  of  the  heated  shoe 
uj)on  the  hoof,  the  percussion  of  the  blacksmith's  hammer  and 
the  pressiure  of  the  shoe  and  of  the  nails  uj)on  the  Hving  tissues, 
that  all  these  causes  together  must,  as  their  sure  effect,  make  the 
foot  tender,  and  stimulate  in  its  constituting  structxu'e,  the  con- 
gestion which  is  the  initial  phenomenon  of  founder  itself.  But 
this  assumption  may  be  successfully  contested.  But  shoeing  may 
produce  many  forms  of  lameness ;  never  laminitis.  It  has  been 
said  that  feet  of  defective  conformation  are  more  commonly  af- 
fected with  founder  that  those  which  are  well  formed.  This, 
however,  is  not  so ;  feet  with  contracted  heels  are  no  more  predis- 
posed to  it  than  flat  feet,  as  claimed  by  Girard.  Traumatic  acci- 
dents, as  blows,  injuries  and  pressure,  produced  by  stones,  crush- 
ing of  the  feet  under  heavy  weights  or  under  the  wheels  of  a 
truck,  etc.,  may  produce  a  violent  congestion  of  the  reticular  tis- 
sue of  the  foot,  and  consequently  laminitis.  But  this  founder 
itself  is  of  too  active  a  character  and  more  complex,  perhaps  with 
a  natural  tendency  to  suppuration,  as  we  have  already  said.  It 
must  then  be  considered  as  varying  from  laminitis  proper,  or  that 
form  in  which  the  congestion  is  of  a  more  passive  character,  or  at 
least  internal  and  somewhat  analagous  to  that  which  is  sometimes 
observed  in  the  lungs  or  in  the  intestines.  It  might  be  better 
described  as  an  "astonishment"  {^tonnement)  of  the  foot,  as  it  is 
sometimes  called. 

Laminitis  proper  is  rarely  due  to  a  unique  cause,  but  more 
properly  to  a  number  of  circumstances  or  to  an  assemblage  of 
various  causes  by  which  the  horse  is  at  first  somewhat  indisposed 


DISEASES. 


687 


— sick  in  fact ;  and  it  is  only  after  various  general  symptoms  that 
the  disease  localizes  itself  in  the  feet,  or,  as  the  old  phraseology 
has  it,  falls  in  the  feet. 

The  most  effective  cause  is  too  abundant  and  especially  too 
substantial  feeding,  which  produces  plethora  by  rich  blood.  It 
is  the  use  of  other  grains  than  oats,  as  wheat,  barley  or  rye, 
which  especially  predisposes  to  the  disease.  Latin  authors  called 
it  hordeatlo  (from  hordeum,  barley),  and  it  is  mentioned  by  Sol- 
leysel,  Garsault,  Gaspard  de  Saunier,  and  various  hippiatrics. 
Rodet  has  observed  its  bad  effects  in  Egypt  and  in  Spain,  where 
animals  were  fed  not  only  with  those  grains,  but  where  they  received 
wheat  in  spike.  MHtenberger  had  observed  the  same  effects  dur- 
ing the  war  of  1812,  in  Poland,  where  the  horses  were  fed  with 
rye.  Even  in  our  days  laminitis  is  seen  breaking  out  in  the  years 
when  feed  is  scarce  and  when  oats  have  to  be  replaced  by  other 
grains,  as  is  proved  by  the  observations  of  Bouley,  Verrier,  Key, 
etc.  Artificial  varieties  of  fodder  also  predispose  to  founder, 
though  less  often  ;  even  oats,  when  given  in  excess,  may  produce 
it  (SoUeysel,  Blind),  and  especially  if  new  oats  (Hertwig). 

The  influence  of  seasons  cannot  be  denied,  and  it  is  during 
the  summer  months  that  laminitis  is  more  frequent,  while  it  is 
rare  in  winter,  as  well  as  in  the  spring  and  fall.  It  is  to  the  warm 
chmates  of  Spain  and  Egypt  that  Rodet  attributed,  in  great  part, 
the  frequency  of  the  founder  observed  in  the  army  horses  en- 
gaged in  campaigning  in  those  countries.  It  has  been  also  attrib- 
uted to  the  su.dden  checking  of  the  perspiration,  and  cutaneous 
chills  when  the  animals  are  sweating ;  a  cold  bath  or  the  drink- 
ing of  cold  water  at  that  moment  having  also  often  been  consid- 
ered as  occasional  causes. 

The  work  of  the  horse  greatly  influences  the  development  of 
laminitis.  It  is  more  frequent  in  those  which  are  driven  at  great 
speed  than  in  those  which  work  while  walking,  and  especially  in 
whose  frame  an  excess  of  strength  is  required,  and  particularly 
those  which  labor  on  rough  and  stony  ground.  It  is  almost  in- 
evitable if  the  animal  is  well  fed,  and  if  he  is  unaccustomed  to 
that  kind  of  work  and  not  trained  for  it,  and  most  especially  if  it 
is  during  warm  weather.  This  explains  why  the  disease  was  so 
frequent  among  post,  diligence  and  coach  horses,  especially  diu'- 
ing  the  period  preceding  the  establishment  of  railroads,  when  the 
expenditure  of  strength  exacted  from  these  unfortunate  animals 


688  OPERATIONS    ON    THE    FOOT. 

reached  the  last  limits  of  possibility.  More  recently,  again,  dur- 
ing the  war  of  1870-71,  when  railroad  traveling  was  more  or  less 
impeded,  laminitis  became  more  common  among  horses  from 
which  an  excess  of  muscular  effort  was  requu'ed.  It  is  a  frequent 
and  ver}'  serious  accident  among  English  race  horses  (Hering). 

Laminitis  in  oxen  is  due  almost  exclusively  to  the  fatigue  of 
long  journeys  and  to  repeated  frictions  of  the  unshod  feet  ujDon 
the  ground.  It  was  very  common  before  the  era  of  raHroads  in 
animals  brought  to  market. 

But  prolonged  rest  and  inaction  also  jn-edisj^ose  to  founder. 
The  disease  is  frequent  in  horses  making  sea  voyages.  It  is  not 
rare  to  see  horses  become  foundered  when  they  are  obliged  to 
stand  uj)  during  several  days  in  consequence  of  injuries  to  the  ex- 
tremities, or  other  pathological  conditions,  requiring  them  to  be 
kept  in  slings.  In  diseases  of  the  feet  which  have  requii-ed  pain- 
ful operations  (toe  or  quarter  cracks,  punctiu-ed  wounds  of  the 
feet,  quittor,  etc.)  it  is  quite  common  to  see  an  animal  persevere 
in  maintaining  the  standing  jjosition,  and  too  often  has  the  leg 
corresponding  to  one  first  attacked  become  also  affected,  leaving 
both  of  the  anterior  or  both  of  the  j)osterior  ultimately  affected  in 
a  serious  manner. 

It  is  common  for  laminitis  to  follow  intestinal  congestions, 
especially  if  these  result  from  the  administration  of  a  drastic 
purge,  as  aloes  for  example,  and  this  is  a  very  serious  form  of  the 
disease.  Tisserand  has  seen  laminitis  of  the  anterior  extremities 
following  j)arturition  in  mares,  and  particularly  after  abortion. 
Gloag  and  Smith  have  observed  similar  facts.  Hertwig  says  that 
it  sometimes  follows  rheumatismal  affections,  especially  the  acute 
foi'm. 

A  metastatic  laminitis  has  been  seen  following  diseases  of  the 
chest.  H.  Bouley  does  not  believe  in  these  cases,  and  thinks  the 
laminitis  is  the  effect  of  the  quadrupedal  standing  position,  or 
also  the  feeding  with  farinaceous  substances  in  too  great  quantity. 
At  times,  founder  accompanies  malignant  fevers,  such  as  anthrax 
and  typhoid  attacks,  which  are  always  accompanied  with  a  certain 
alteration  of  the  blood    * 

VII.  Treatment. — In  acute  laminitis  all  attempts  must  tend 
to  remove  the  congestion  of  the  keratogenous  apparatus,  or  at 
least  to  abate  its  intensity,  so  as  to  prevent  or  diminish  the  seri- 
ous sequelae  that  may  too  often  follow.     To  effect  this,  general  or 


689 


local  bleedings  have  been  specially  recommended,  with  antiphlo- 
gistic aj)pHcations  upon  the  congested  regions.  General  bleeding 
at  the  jugular  is  especially  indicated;  a  large  bleeding  of  from 
five  to  ten  litres,  repeated  if  the  pulse  or  the  condition  of  the  dis- 
ease indicates  it.  Local  bleeding,  often  recommended,  seems  to 
us,  generally  speaking,  to  be  useless  ;  that  of  the  toe  is  of  difficult 
performance  in  founder,  as  the  feet  are  usually  raised  from  the 
ground  with  difficulty,  and  the  operation  is  quite  painful,  and 
may  give  rise  to  more  or  less  serious  complications.  However,  in 
serious  cases  it  can  be  done  while  the  animal  is  thrown  down,  not 
so  much  on  account  of  the  blood  depletion  as  to  prevent  the  pos- 
sibility of  gangrene  supervening.  It  is  more  useful  in  the  ox, 
according  to  Lafosse,  who  recommends  to  pare  the  foot  down  to 
the  quick  and  to  put  on  the  shoe  again  if  the  animal  has  to  con- 
tinue its  journey. 

The  topical  applications  employed  are  varied  and  numerous ; 
the  simplest  and  most  practical  is  cold  water,  cold  baths  at  half 
the  leg  (Fig.  520) ;  take  in  running  water, 
if  it  can  be  done,  and  if  the  animal  stands 
up;  walking  in  the  water  is  then  recom- 
mended, if  practicable,  walking  increasing 
the  venous  circulation  of  the  part.  Instead 
of  running  water,  ponds,  marshy  grounds, 
pools  of  stagnant  water,  or  even  Uquid 
manure  may  serve  the  same  purpose.  In 
establishments  where  horses  are  numerous, 
there  are  special  tubs  where  the  water  is 
constantly  changed.  The  animal  may  be 
placed  in  some  of  these,  up  to  his  fetlock, 
in  an  astringent  solution.  Mathew  has  in- 
vented an  apparatus  for  continued  irriga-  figs.  520. 
tion,  consisting  of  a  reservoir  of  water  ele 
vated  above  the  body  of  the  animal ;  around  each  coronet  is  placed, 
in  shape  of  a  bracket,  a  tube  of  india  rubber,  perforated  with  holes 
opening  on  the  hoof ;  from  the  reservoir  rvins  a  tube  which  bifur- 
cates and  furnishes  to  each  leg  a  descending  division  connected 
with  the  bracket  (Fig.  521).  The  water  is  then  allowed  to  run 
around  the  coronet  and  drip  over  the  foot.  Instead  of  simple 
water,  the  use  of  snow  or  broken  ice  has  been  recommended, 
wrapped  in  cloth  round  the  hoof ;  pads  of  oakum  dipped  in  solu- 


Local  Cold  Douch 
Application. 


690 


OPEEATIONS   ON   THE  FOOT. 


Fig.  521.— Apparatus  of  Mathew  for  Cold  Water  Application. 

tion  of  salt,  sulphate  of  iron,  or  alum ;  clay  poultices  mixed  with 
vinegar  have  also  been  used.  As  the  heat  of  the  foot  has  a  ten- 
dency to  rise,  the  temperature  of  the  liquid  or  of  the  topic  used 
must  be  often  changed  in  order  to  keep  up  its  antiphlogistic  ef- 
fect. Baths  of  sulphate  of  iron  are  especially  indicated  in  cases 
of  traumatism. 

Irritating  frictions,  used  as  derivatives,  are  also  recommended, 
but  their  efficacy  in  this  case  is  at  least  problematical.  Irritation, 
when  the  congestion  is  somewhat  passive,  is  not  easy  to  produce. 
However,  frictions  of  the  hock  with  oil  of  turpentine,  by  the  pain 
they  produce  stimulating  the  animal  to  move  and  not  allowing 
him  to  remain  in  a  state  of  almost  complete  immobility,  may  be 
advantageous.  Blisters  around  the  coronet  are  useful  toward  the 
third  or  fourth  day,  when  plastic  exudation  or  hypersecretion  of 
the  hoof  are  to  be  feared. 

Frog  seton  is  recommended  by  English  practitioners  ;  Gabriel 
says  it  is  a  sure  means  to  prevent  the  separation  of  the  nail.  This 
seems  to  us  unwarranted.  Internally,  the  administration  of  ni- 
tre, cream  of  tartar,  ammoniacal  salts,  sulphate  of  soda,  are  given ; 
drugs  which  are  indicated  by  the  febril  state  ;  alkaline  remedies, 
and  principally  of  nitrate  of  potash  in  large  doses,  are  administered 
to  render  the  blood  more  fluid  and  increase  the  venous  circulation. 
Aloes,  recommended  in  England  by  Hertwig,  are  contra-indicated, 
as  increasing  the  disease  and  facilitating  the  dropping  of  the  foot. 


DISEASES.  691 

It  has  been  advised  to  take  the  shoes  off.  This  is  not  only  a 
difficult  operation,  on  account  of  the  sufferings  of  the  animal,  ob- 
liged to  stand  upon  one  leg,  but  it  seems  to  us  useless.  Shoeing 
has  not  the  effect  supposed  of  it  in  the  etiology.  If  it  is  well 
fitted  it  is  not  uncomfortable  to  the  foot,  while  its  removal  from 
the  foot,  hy  the  hammering  it  requu'es,  is  always  painful,  and  had 
better  be  avoided. 

It  has  been  recommended  to  pare  the  foot,  to  shorten  it,  to 
thin  the  sole  down ;  but  this  operation  seems  to  us  in  many  cases 
superfluous.  It  is  true  that  the  topics  will  act  more  readily  upon 
the  living  tissues  underneath,  but  the  advantages  thus  obtained 
do  not  compensate  for  the  difficulty  of  the  operation;  at  any  rate, 
it  cannot  be  done' except  when  the  animal  lies  down. 

We  shall  pass  silently  the  effect,  so  to  speak  homeopathic, 
that  English  veterinarians  pretend  to  obtain  with  very  warm 
poultices  around  the  foot,  and  which  have  their  reasons  only  when 
suppuration  or  gangrene  is  threatening.  Neither  shall  we  refer 
to  the  compression  of  the  foot,  recommended  by  Nanzio — a  treat- 
ment which  is  much  nicer  in  theory  than  in  practice.  In  a  great 
number  of  cases,  the  patient  is  considerably  relieved  by  resting 
on  a  good  bed,  and  this  is  especially  necessary  for  severe  laminitis 
when  locomotion  is  very  painful.  However,  in  less  serious  cases, 
walking  on  soft  ground,  especially  on  grass,  is  an  excellent  treat- 
ment. It  stimulates  the  circulation  in  parts  where  the  blood  has 
a  tendency  to  accumulate,  and  controls  the  venous  engorgement 
of  the  keratogenous  tissue.  It  has  been  sometimes  recommended 
to  support  the  animal  in  slings  to  relieve  him ;  but  as  with  this 
one  would  expose  his  patient  to  pulmonary  complication,  it  is  bet- 
ter to  cast  him  and  keep  him  in  that  forced  position,  being  careful 
to  turn  him  over  from  time  to  time. 

A  dietetic  regime,  light  feeding,  during  the  first  days  at  least, 
cooling  drinks,  rectal  injections  and  comfortable  blankets  are  all 
indicated. 

One  must  particularly  watch  what  takes  place  in  the  foot,  and 
for  this  purpose  grooves  made  at  the  surface  of  the  foot  have  also 
been  recommended;  but  they  cannot  be  made  deep  enough,  as 
the  wall  is  always  there  resisting  more  or  less  to  the  eccentric 
forces  of  the  deep  parts. 

If  toward  the  third  or  fourth  day  there  is  no  marked  improve- 
ment, especially  in  traumatic  founder,  if  even  the  patient  becomes 


692  OPERATIONS    ON    THE    FOOT. 

worse,  if  the  pulsation  at  the  digital  arteries  is  stronger,  harder 
and  more  frequent,  it  becomes  necessary  at  once  to  thin  the  sole 
down,  and  make  a  puncture  upon  the  Une  of  demarcation  of  the 
sole  and  wall  with  the  drawing  knife.  Often  then  a  flow  of  pus 
or  blood,  more  or  less  altered,  takes  place,  the  nature  of  which  in- 
dicates the  progress  of  the  disease.  If  it  is  of  a  grey  blackish 
color,  it  is  evidence  that  the  homy  tissue  only  is  affected ;  while  if 
white,  it  indicates  a  greater  change.  Hertwig  advises  this  opera- 
tion always,  when  laminitis  is  of  long  duration.  He  thus  pro- 
duces an  artificial  seedy  toe,  which  is  considered  the  mildest  form 
of  the  disease.  He  recommends  to  make  a  deep  groove  upon  this 
white  line  so  far  as  there  is  separation  of  the  wall  from  the  podo- 
phyllous  tissue,  and  then  combines  the  treatment  with  the  use  of 
astringent  baths  of  suljohate  of  copper.  We  have,  on  several  oc- 
casions, been  pleased  with  this  treatment,  combining  it  with  the 
application  of  a  blister  around  the  coronet.  It  is  preferable  to 
the  longitudinal  grooves,  or  to  trephining,  which  is  sometimes 
recommended. 

There  are  numerous  cases,  however,  when,  notwithstanding  all 
these  rational  means,  the  disease  cannot  be  arrested,  and  when  a 
fatally  chronic  laminitis  ensues.  This  must  be  considered  incur- 
able in  the  majority  of  cases.  It  is  almost  impossible  to  bring 
the  foot  back  to  its  physiological  condition,  and,  above  all,  to  pre- 
vent the  hypersecretion  of  the  hoof  which  characterizes  it. 

However,  in  case  of  simple  seedy  toe,  if  it  is  the  result  of 
hemorrhage,  or  even  of  suppuration,  a  cure  may  sometime  be  ob- 
tained. Generally,  by  thinning  it  down,  the  entire  portion  of  the 
wall  which,  at  the  toe,  the  mammae  and  the  anterior  part  of  the 
quarters  is  superposed,  to  the  keraphyllous  hoof,  without  adhering 
to  it,  is  removed.  The  keraphyllous  hoof,  also,  is  thinned  down 
in  its  whole  extent ;  then  a  dressing  of  hoof  ointment  or  tar  is  ap- 
plied so  as  to  protect  it  from  drying  and  to  keep  it  supj^le.  In 
these  cases,  the  hoof  coming  down  from  the  coronary  band  has 
sometimes  united  with  that  flowing  over  the  podophjdloiis  laminae. 
At  other  times  the  seedy  toe  is  only  cleaned  of  its  contents,  and 
is  filled  with  medicated  oakum,  if  there  is  a  wound  of  the  j)odo- 
phyllous  tissue,  or  with  hoof  ointment  and  Venice  turpentine,  the 
whole  being  kept  in  place  by  a  wide  web  shoe.  The  last  treat- 
ment seems  to  us  the  best,  only  instead  of  hoof  ointment  we  em- 
ploy gutta  percha,  melted  with  gum  ammoniac,  as  recommended 


DISEASES.  t)93 

by  Defays.  For  this  there  must  be  uo  wound,  and  the  ca\dty 
must  be  well  cleaned  of  all  substances,  or  even  washed  with  ether 
to  remove  all  greasy  substances  which  would  prevent  the  gutta 
percha  from  adhesion  with  the  hoof.  This  course  has  enabled  us 
to  see  deep  seedy  toes  recover  by  the  gradual  growth  of  the  foot. 
Hence,  the  indication  to  try  to  obtain  an  artificial  seedy  toe  as 
early  as  possible,  as  recommended  by  Her  twig. 

AVhen  there  is  thickening  of  the  keraphyllous  horn  and  adhes- 
ion with  the  wall ;  when,  also,  the  toe  is  formed  entirely  by  a  de- 
formed horny  mass,  the  case  is  more  serious  and  the  treatment 
more  uncertain.  It  has  been  recommended,  wrongly,  we  believe, 
to  perform  the  operation  which  consists  in  cutting  off  all  the  pro- 
truding hoof — to  even  cut  off  all  the  accidental  production.  To 
do  this  the  rasp  and  drawing-knife  are  used,  the  keraphyllous  mass 
being  thrown  down  as  much  as  possible.  D'Arboval  has  also  ad- 
vised to  make  with  the  drawing-knife  an  artificial  seedy  toe  be- 
tween the  internal  face  of  the  wall  proper,  which  is  preserved,  and 
the  anterior  face  of  the  podophyllous  apparatus,  upon  which  a 
thin  layer  is  left.  This  treatment  has  an  advantage  over  the  other 
of  keeping  the  wall  intact,  to  render  easier  and  more  solid  the 
application  of  the  shoe  which  is  to  protect  the  foot  and  allow  the 
animal  to  resume  his  work.  This  operation,  however,  is  only  pal- 
liative. It,  however,  gives  great  relief,  especially  in  the  first  steps 
of  chronic  laminitis. 

Gross  has  been  satisfied  with  thinning  down  with  the  rasp  the 
suj^erior  part  of  the  wall,  below  the  coronet,  in  a  width  of  about 
four  centimeters,  in  such  a  way  that  from  one  heel  to  the  other 
there  was  only  a  very  thin  coat^  which  he  protected  with  basilicon 
ointment.  The  coronet  was  then  stimulated  with  a  little  oil  of 
cantharides.  Under  this  treatment,  a  new  growth  of  hoof  is 
started,  not  so  protruding,  and  by  paring  down  by  degrees  the 
hoof,  a  new  foot  was  grown  in  a  few  months,  less  deformed  and 
more  regular. 

Meyer  and  Gunther  say  that  they  have  obtained  good  success 
with  this  treatment,  which  nearly  resembles  that  of  Gohier  and 
Dehan,  except  that  with  those  the  entire  wall  was  pared  down  to 
a  thin  pellicle,  flexible  under  the  pressure  of  the  finger.  Silber- 
man  advised  to  place  around  the  hoof,  below  the  coronary  band, 
after  paring  it  down  thin,  a  baud  of  steel,  two  fingers  wide,  which 
could  be  tightened  by  a  screw  placed  at  the  heels.     In  this  way 


694  OPERATIONS    ON    THE    FOOT. 

the  secretion  of  the  coronary  band  was  kept  under  control,  but 
not  that  of  the  podophyllous  tissue. 

Generally  in  these  cases  the  suppleness  of  the  hoof  must  be 
kept  up  by  appropriate  topics.  It  must  be  cut  off  when  too  thick, 
and  a  shoe  must  be  applied  sufficiently  wide  in  the  web  to  protect 
the  anterior  part  of  the  sole  as  far  as  the  point  of  the  frog.  This 
shoe  must  be  quite  hollow  on  the  foot  surface,  so  as  to  avoid  any 
pressure  upon  the  sole.  It  must  be  nailed  on  principally  at  the 
heels,  as  nails  at  the  toe  would  not  hold  sufficiently.  Between  the 
shoe  and  the  foot  a  piece  of  gutta  percha,  or  felt  or  leather  may 
be  put  on.  Thus  shod,  a  horse  will  still  do  long  service,  even  in 
cities,  and  much  more  in  the  country. 

When  there  is  a  wound  at  the  sole,  with  separation  of  the  part, 
suppuration,  caries  of  the  os  pedis,  which  protrudes  through  the 
sole,  it  is  advised  to  have  recourse  to  a  surgical  oj)eration.  The 
contents  of  the  abscess  under  the  sole  must  be  evacuated,  and  the 
sole  thinned  down  in  the  entire  plantar  region.  If  the  bone  is 
carious  it  is  scraped,  the  necrosed  parts  are  removed,  and  a  proper 
dressing,  kept  up  by  plates  under  the  shoe,  is  jDut  on.  There  are 
a  few  cases  where,  by  this  treatment,  horses  have  been  enabled  to 
resume  their  work. 

Often  in  chronic  laminitis  when,  notwithstanding  the  opera- 
tion and  the  shoeing,  the  horse  is  unable  to  resume  his  work,  ac- 
cording to  H.  Bouley,  the  operation  of  neurotomy  will  then  be 
beneficial.  Grad  is  not  of  the  same  opinion.  He  claims  that  the 
relief  is  then  uncertain  and  only  temporary.  Jessen  and  Hering 
say  that  this  operation  is  followed  very  often  by  the  sloughing  of 
the  hoof,  and  the  animals  stumble  very  easily.  According  to 
Braull  this  operation  is  followed  by  a  greater  growth  of  the  hoof. 
If  the  lameness  is  reduced  after  the  operation  the  deformity  of 
the  foot  continues  to  increase. 

Navicular  Disease. 

Synonyms. —  Chronische  Hufgenklahme,  German;  Maladie 
Namculaire,  French.  This  disease,  called  by  Loisel  and  H.  'S>ovl- 
\e^,  j)odosesmnoideal  synovitis  (synovite  podosesamoidienne) ;  by 
Braull,  chronic  podotrochlitis,  is  an  inflammation  of  the  sesamoid 
sheath  of  the  horse,  that  Turner  and  some  other  English  veterin- 
arians were  the  first  to  describe,  and  which  is  mostly  observed  in 
thoroughbreds. 


DISEASES.  695 

The  disease  is  i^rincipally  seen  in  the  fore  feet,  and  more  com- 
monly in  one  foot  alone ;  sometimes,  however,  both  legs  are 
affected,  one  first,  and  the  other  following.  Navicular  disease  of 
the  hind  feet  is  seldom  observed. 

It  is  accompanied  with  lameness  and  deformity  of  the  foot, 
and  often  proves  rebeUious  to  treatment.  It  is  followed  by  con- 
traction of  the  heels  {encastelure)  which  is  itself  often  mistaken 
for  navicular  disease.  At  any  rate,  the  affections  are  nearly  re- 
lated, whether  the  disease  of  the  sesamoid  sheath,  first  occurring, 
is  followed  by  the  contraction,  or  that  the  hoof,  originally  con- 
tracted, gives  rise  to  the  subsequent  alterations  of  structure 
which  constitute  navicularthritis.  At  present  we  shall  only  con- 
sider the  deep  inflammation  of  the  podosesamoideal  articulation, 
occurring  without  primitive  alteration  in  the  form  of  the  foot. 

I.  Symjytoms.  —  These  are  at  first  obscure.  The  lesion  is 
deeply  situated,  and  is,  so  to  speak,  concealed  in  the  hoof,  which 
itself,  is  generally  at  first  of  very  hmited  extent.  The  first  symp- 
tom which  attracts  attention  is  the  lameness,  which  sometimes, 
indeed,  seems  to  be  merely  a  certain  weakness  of  the  affected  leg. 
This  lameness  is  at  first  intermittent  and  slight,  but  gradually  in- 
creases. When  in  the  stable,  the  animal  "  j)oints,"  that  is,  the  dis- 
eased foot  is  carried  forward  of  a  vertical  hne,  and  assunjes  a 
state  of  general  relaxation  of  the  muscles,  with  the  coronet 
straightened  and  the  foot  mostly  resting  on  the  toe.  This  in- 
complete rest  of  the  leg,  which  is  sometimes  kept  in  motion  for- 
ward and  backward,  becomes  especially  apparent  if  the  animal  is 
moved  backward  in  his  stall.  He  then  sets  down  his  foot  with 
much  hesitation,  and  for  a  short  time ;  the  same  thing  also  occurs 
when,  in  order  to  relieve  the  opposite  leg,  the  animal  puts  all  his 
weight  on  the  diseased  one.  Still,  a  close  examination  of  the  foot 
fails  to  reveal  any  marked  lesion ;  no  change  of  form  appearing, 
no  wain  at  the  coronary  band;  merely  a  little  heat  toward  the 
heels,  or  on  the  frog,  where  there  can  also  be  found  a  certain 
amount  of  low  and  deep  sensibility,  made  aj^parent  only  by  per- 
cussion of  the  hammer  upon  the  foot,  or  by  the  pressure  with  the 
blacksmith's  nippers,  principally  toward  the  heels  and  the  frog. 
According  to  Lafosse,  the  frog  is  often  found  indurated,  atrophied 
and  thrushy.  If  exercised,  the  horse  frequently  stumbles,  and 
sometimes  falls  on  his  knees ;  he  fears  the  pain  of  resting  the 
heels  on  the  ground,  and  is  limited  in  the  movements  of  his  knee 


OyO  OPERATIONS    OX    THE    FOOT. 

and  fetlock.  If  the  heels  are  pared  off,  in  such  a  manner  that  the 
frog-  is  well  prominent,  and  the  horse  becomes  much  heated,  the 
lameness  is  increased,  although  at  first  it  may  have  been  very 
slight.  Blacksmiths  may  frequently  obtain  the  same  result  by 
placing  under  the  foot  a  bar  shoe,  which,  then  resting  on  the  frog, 
and  not  the  heels,  greatly  aggravates  the  lameness  until  it  be- 
comes excessive.  This  mode  of  diagnosis  was  originally  indicated 
by  Brauell :  When,  after  more  or  less  exercise,  the  animal  is  left 
to  cool  off,  he  at  once  points,  straightens  his  fetlock,  and  slightly 
flexes  the  knee;  the  leg  has  a  trembling  motion,  and  no  rest  is 
taken  upon  the  heels. 

There  are,  however,  according  to  Hertwig,  cases  where  navicu- 
lar disease  suddenly  reaches  a  period  where,  in  the  stable,  the 
animal  avoids  all  resting  on  the  heel ;  points  constantly,  and  hes- 
itates to  put  his  foot  on  the  ground  when  made  to  walk.  It  al- 
ways seems  that  there  must  be  some  traumatic  lesion  in  the  foot, 
as  a  punctured  wound  or  a  suppurating  corn ;  and  still  there  is 
no  increased  heat  in  the  hoof,  and  no  extraordinary  x^ulsation  of 
the  arteries  of  the  foot. 

The  disease  has  a  tendency  to  increase,  and  the  animal  soon 
becomes  very  lame  upon  being  put  to  work,  especially  on  a  hard 
road  or  rough  ground.  The  heat  of  the  foot  is  increased  princi- 
pally after  work,  though  not  in  proj)ortion  to  the  lameness.  The 
sensibility  of  the  foot  is  also  more  manifest  under  the  exploring 
pressure  of  the  nippers.  In  the  stable  the  pointing  is  well 
marked,  and  the  trembhng  of  the  leg  gives  signs  of  deep  and  per- 
sistent pain.  It  is  only  after  several  months  of  this  suffering  that 
the  foot  begins  gradually  to  show  a  change  of  shape.  It  then  be- 
comes visibly  narrowed  and  elongated,  in  a  manner  which  can 
readily  be  detected  both  by  sight  and  management.  There  is  a 
general  atrophy  of  the  hoof;  the  periople  has  disappeared,  or 
scales  off;  the  foot  becomes  covered  with  ridges,  more  or  less 
marked,  but  better  developed  toward  the  heels ;  the  frog  has  be- 
become  sunken  and  atrophied;  the  sole  is  ecchymosed,  present- 
ing evidences  of  corns ;  and  the  leg  is  atrophied,  esj)ecially  about 
the  muscles  of  the  shoulder. 

In  cases  where  both  fore  feet  are  affected,  the  animal  points 
with  either  foot  alternately,  while  seeking  the  desired  relief  for 
each,  but  the  rest  on  either  is  very  short.  The  hind  legs  are 
brought  under  the  centre  of  gravity,  the  back  is  arched,  and  the 


DISEASES.  697 

decubitus  prolonged.  In  stepping  out  of  the  stable,  both  fore 
feet  are  held  stiffly,  and  kept  close  to  the  ground,  the  animal 
stumbles  on  his  fetlocks,  and  often  falls,  and  one  might  suspect 
him  of  being  weak.  In  walking,  his  shoulders  seem  to  be  rigidly 
attached  to  his  body,  but  as  he  warms  up  the  legs  move  more 
freely  and  his  actions  become  less  limited ;  but  immediately  on 
cooling  off,  and  especially  the  day  following  one  of  hard  work,  all 
the  symptoms  reappear,  with  even  aggravated  intensity.  The 
disease  increases  steadily  with  the  lapse  of  time.  When  one,  or 
what  is  more  rarely  the  case,  both  hind  feet  are  affected  (Loiset 
has  seen  it  occur),  the  animal  is  stiff  behind;  he  is  lame  on  one  or 
both  feet ;  he  puts  his  foot  on  the  toe  only ;  knuckles  at  the  fet- 
lock; and  presently  an  atrophy  of  the  muscles  of  the  superior 
regions  takes  place. 

II.  Progress^  Duration,  Termination. — The  disease  gener- 
ally maintains  a  steady  progress ;  nevertheless  it  very  often  un- 
dergoes a  remission,  due  to  the  hygienic  conditions  in  which  the 
animal  is  placed;  to  the  seasons;  to  the  state  of  the  atmosphere, 
and  to  other  causes.  It  may  diminish  in  severity,  and  its  symp- 
toms disapi:»ear,  while  in  its  first  period,  if  the  animals  are  left  at 
rest — without  shoes  if  possible — loose  in  a  box,  with  damp  bed- 
ding, or  in  a  marshy  field ;  or  in  winter,  during  the  rainy  season, 
while  the  atmosphere  continues  in  a  moist  condition  for  a  long 
period.  It  is,  under  these  circumstances,  not  uncommon  to  see 
feet  which  had  become  contracted  quite  recover  their  natural  di- 
mensions. Aside  from  these  exceptional  cases  of  recovery,  the 
lesion  keeps  on  slowly  destroying  the  tissues  where  it  exists ;  the 
lameness  remains  constant,  oi*  becomes  intermittent  for  years, 
sometimes  after  the  animals  have  become  entirel}^  unfit  for  work 
There  are  frequent  complications  involving  the  surrounding 
parts ;  sometimes  a  true  arthritis,  and  besides  the  complete  atro- 
phy of  the  muscles  of  the  shoulder,  the  carpal  ligament  becomes 
thickened,  the  tendon  of  the  perforans  undergoes  the  same  alter- 
ation, and  ring-bones  and  side-bones  may  follow.  Again,  how- 
ever, the  animal  may  become  knuckled  to  such  a  degree  that  he 
can  scarcely  rest  his  foot  on  the  ground  at  all. 

III.  Pathological  Anatomy. — As  we  have  said,  the  disease 
has  its  seat  in  the  sjTiovial  capsule,  formed  by  the  small  sesamoid 
sheath  between  the  navicular  bone  and  the  perforans  tendon,  slid- 
ing upon  it.     At  first  may  be  observed  a  certain  injection  of  the 


byo  OPEKATIONS    ON    THE    FOOT, 

synovia,  and  a  darker  hue  in  the  coloration  of  the  trochlear  carti- 
lage with  the  corresp.onding  face  of  the  tendon,  the  synovia  be- 
coming reddish  and  thick,  the  surrounding  cellular  tissue  becom- 
ing, also,  inflamed  and  infiltrated.  At  a  later  jDcriod,  when  the 
disease  has  somewhat  progressed,  there  is  a  thickening  of  the 
walls  of  the  cajjsule,  which  is  then  filled  with  a  clear  citrine  ser- 
osity.  There  is  then,  a  kind  of  hygroma,  a  chronic  dropsical  con- 
dition of  the  sheath.  In  the  interior  of  this  are  also  to  be  found 
fibrous  bands,  running  from  the  tendon  to  the  bone.  If  the  dis- 
ease is  older,  erosions  are  found  ujDon  the  diarthrodial  surface 
of  the  navicular  varying  in  number  and  in  size,  and  the  tendon 
is  roughened  on  its  anterior  face  with  longitudinal  fissures.  At 
times,  it  becomes  atrophied  and  thin,  dry  and  brittle;  and  has 
been  found,  it  is  said,  ruptured  transversely.  In  many  cases,  the 
cartilage  covering  the  bone  has  disappeared  and  the  bone  is  ex- 
posed, hollowed  and  afi"ected  with  osteoporosis.  The  union  of  the 
bone  with  the  tendon  has  also  been  found  among  the  varieties  of 
determination. 

IV.  Diagnosis. — This  disease  is  at  first  easily  mistaken  for 
some  form  of  rheumatic  affection.  "Where  jDain  is  the  main  symp- 
tom it  is  easily  detected,  but  where  there  are  no  other  signs  of  in- 
flammation, it  is  just  the  lack  of  j)roj)ortion  between  the  intensity 
of  the  lameness  and  the  serious  sym2:)toms,  such  as  the  absence 
of  heat ;  of  special  sensibility ;  of  pulsations  in  the  digits,  which 
distinguishes  navicular  disease  from  other  affections  of  the  feet. 
The  error  with  contracted  heels  is  easier,  as  here  the  change  of 
form  of  the  foot  being  primitive,  at  once  attracts  the  attention  of 
the  practitioner ;  while  this  alteration  in  the  foot  is  absent  in 
navicularthritis  at  the  outset  of  the  disease. 

V.  Prognosis.  —  Generally,  it  is  unfavorable,  as  most  com- 
monly the  veterinarian  is  called  only  when  the  disease  has  already 
made  serious  progress  and  passed  into  the  chronic  stage ;  and 
again,  because  of  the  difficulty  of  reaching  the  disease  by  reason 
of  its  peculiar  location. 

VI.  Etiology. — To  j)ro23erly  understand  the  etiology  of  this 
disease,  one  must  bear  in  mind  the  part  played  by  the  anterior 
legs  in  the  action  of  locomotion.  Columns  of  suj^port  more  than 
of  impulsion,  it  is  their  office  to  sustain  the  weight  of  the  body 
when  it  is  thrown  forward  by  the  extension  of  the  hind  legs.  The 
reaction  of  the  ground  is  first  felt  at  the  shoulders,  through  the 


DISEASES.  699 

muscular  slings  which  attach  them  to  the  trunk,  but  it  is  partly 
diminished  in  the  scapulo-humeral  joint,  which  closes,  notwith- 
standing the  resistance  of  the  muscles  implanted  on  its  apex.  The 
remaining  force  is  transmitted  to  the  vertical  column,  represented 
by  the  union  of  the  radius,  the  carjDus  and  the  metacarpus.  Reach- 
ing the  digital  region,  this  force  is  there  decomposed.  Part  of  it, 
passing  on  the  phalanx,  loses  itself  and  disaj^pears  in  front  of  the 
horny  box  of  the  foot,  the  other  being  thrown  uj)on  the  flexor 
tendons,  and  finally  upon  the  perforans,  which  distributes  it  to 
the  posterior  parts  of  the  foot,  and  to  the  navicular  bone.  It  must 
be  observed  that  in  this  complex  action  of  decomposition  of  the 
shock,  the  os  sesamoid,  though  pushed  from  before  backward  by 
the  OS  coronse  is,  however,  supported  by  the  resistance  of  the  per- 
forans tendon.  Consequently,  both  the  bone  and  the  tendon  are 
pressing  upon  each  other,  when  the  feet  are  placed  on  the  ground, 
throwing  the  body  forward  by  the  impulse  of  the  hinder  parts, 
and  thus  press  powerfully  against  each  other. 

When  this  pressure  takes  place  in  an  animal  going  full  speed, 
and  a  good  and  high  stepper,  it  may  commence  by  becoming 
merely  a  slight  confusion,  but,  if  often  repeated,  the  result  may 
be  some  lesion  upon  the  corresponding  surface  of  the  bone  and 
of  the  tendon,  or  of  the  synovial  which  facilitates  their  move- 
ments. But  the  energy  of  action  in  the  animal  cannot  be  con- 
sidered the  only  producing  cause  of  these  lesions,  as  a  vice  of 
conformation  in  the  foot,  a  want  of  elasticity  in  its  posterior  parts 
where  the  resisting  power  is  diminished,  may  also  produce  it. 
The  disease,  then,  is  observed  in  animals  whose  plantar  cushion, 
covered  by  a  small,  dry  and  atrophied  frog,  is  itself  badly  devel- 
oped, from  being  compressed  between  the  bars,  which  are  more 
vertical,  or  the  heels,  which  are  more  contracted;  all  these  be- 
ing conditions  which  diminish  the  flexibiUty  of  the  back  of  the 
foot. 

Two  principal  causes,  then,  co-operate  in  the  genesis  of  navi- 
cular disease,  and  are  almost  always  present  in  animals  thus 
affected.  On  the  one  hand,  it  will  appear  among  well-bred  ani- 
mals, especially  those  of  English  breeds,  those  from  Hanover, 
Mecklenburg  and  Normandy,  which  will  be  more  affected.  Loiset 
and  Lafosse,  however,  have  seen  it  in  common  breeds,  in  animals 
with  flat  feet  and  soft  horns.  Lafosse  says  he  has  seen  it  in  mules. 
But  besides  this  influence  of  the  breed,  there  is  the  effect  of  what 


700  OPERATIONS    ON    THE    FOOT. 

we  may  denominate  tile  hygiene  of  the  foot ;  the  too  dry  bedding, 
certain  wrong  modes  of  shoeing  and  all  the  predisposing  causes 
of  contracted  heels.  Let  us  add  also,  as  a  cause,  the  effect  of 
changing  the  animals  from  marshy  fields,  where  they  were  walk- 
ing on  soft,  damp  ground,  to  stables  with  dry  bedding — a  cause 
commonly  present  in  horses  transported  from  northern  Germany 
to  the  south.  Hard  work  and  excessive  exercise  are  also  causes 
of  this  affection — for  example,  jumping  fences  with  a  heavy  rider, 
slipping  in  steeple-chases,  racing,  a  sudden  stop  on  the  fore  feet, 
especially  on  stony,  hard,  frozen  or  rough  ground.  All  these  are 
fruitful  cases  of  navicular  disease. 

Traumatic  causes,  such  as  punctured  wounds,  involving  the 
sesamoideal  sheath,  are  also  productive  causes  which  may  origin- 
ate navicular  disease.  We  do  not  believe  in  internal  causes,  nor 
admit,  with  Loiset,  that  viscei'al  inilammation,  sudden  arrest  of 
perspii'ation,  especially  of  the  lower  part  of  the  legs,  can  produce 
the  disease.  We  should  rather  anticipate  that  these  metastases 
would  affect  more  the  more  important  serous  structure.  Neither 
can  we  admit,  with  Lafosse,  that  this  affection  can  also  follow  a 
sudden  arrest  of  the  milky  secretion. 

VII.  Treatment. — We  have  seen,  in  speaking  of  the  termina- 
tions of  these  lesion,  that  in  certain  peculiar  circumstances  which 
may  be  accounted  favorable  to  the  return  of  the  elasticity  of  the 
foot,  a  spontaneous  recovery  is  possible.  This  leads  us  to  the 
measure  of  the  prophylactic  means  proper  to  be  used;  and  it 
seems  evident  that  by  a  better  hygiene  of  the  feet,  by  rational 
shoeing,  sometimes  educating  young  horses  only  gradually  to  fast 
work,  one  may  in  many  cases  avoid  navicular  disease. 

'\Vhile  it  is  in  its  first  stages,  one  may,  with  care  and  patience, 
sometimes  reheve  the  patient.  In  this  case,  absolute  rest  is  coun- 
ter-indicated, but  on  the  contrary,  moderate  exercise,  upon  even 
and  not  too  hard  ground;  or,  if  the  lameness  is  great,  walking 
exercise  only,  at  a  moderate  gait.  The  absorption  of  the  serosity 
present  is  made  easier  by  a  little  exercise  than  by  absolute  rest. 
Bleeding  from  the  toe,  or  the  veins  of  the  affected  legs,  is  also, 
at  least,  superfluous,  the  disease  becoming  chronic  almost  at  the 
outset.  It  is  also  a  good  practice  to  shoe  the  horse,  and  above 
all,  to  remove  the  shoe  frequently.  The  best  shoeing  is  that 
which  allows  for  the  natural  expansion  of  the  hoof.  The  Charlier 
shoe  has  proved  useful,  while  the  bar  shoe,  which  is  heavier,  and 


DISEASES.  701 

presses  upon  the  frog,  is  counter-indicated.  It  is  important  to  en- 
courage the  suppleness  of  the  hoof  b}'  proper  ointment,  especially 
the  application  of  glycerine,  and  to  have  vinder  the  feet  a  bed- 
ding always  sUghtly  damj)  and  soft.  The  bedding  of  moist  saw- 
dust is  very  convenient ;  we  prefer  it  to  poultices,  and  even  to  the 
tepid  alkaline  baths  mentioned  by  Hertwig.  At  times,  at  inter- 
vals of  about  eight  days,  and  then  during  two  consecutive  days, 
a  good  friction  with  blister  ointment  above  the  coronet  is  advan- 
tageous, as  well  as  one  with  Lebas'  ointment.  English  practi- 
tioners prefer  salines ;  the  better  treatment  would  be  to  turn  the 
animal  to  grass.  Brauell  advises  iodine  internally,  and  says  he 
has  found  it  work  well.  Others  recommend  diuretics.  Setons  in 
the  shoulder  or  chest  seems  to  us  inexpedient.  We  prefer  the  ad- 
ministration of  a  purgative  ball  every  eight  days.  Sewell  and 
Brauell  advise  a  seton,  running  from  the  hollow  of  the  coronet 
through  the  plantar  cushion,  a  little  behind  the  tendon  of  the 
perforans,  and  within  a  short  distance,  therefore,  of  the  diseased 
capsule,  making  its  exit  at  the  anterior  third  of  the  frog.  This 
drain  is  to  be  maintained  for  two,  three,  and  even  four  weeks ; 
Sewell,  Brauell,  Hertwig,  and  several  other  veterinarians,  English 
especially,  claiming  much  benefit  from  it.  This  seton  is  intro- 
duced by  means  of  a  curved  frog  seton-needle ;  it  has  been  used 
but  little  in  France.  Bruner  has  recently  proposed  the  punctui-e 
of  the  sesamoideal  capsrde  with  a  trochar,  introduced  into  the 
hollow  of  the  coronet,  an  operation  only  practicable  if  the  serous 
collection  can  be  felt  outward.  After  the  puncture,  he  recommends 
an  injection  of  iodine. 

Lafosse  proposes  after  the  removal  of  the  sole,  the  transversal 
incision  of  the  plantar  cushion,  with  removal  of  a  part  of  it,  down 
to  the  tendon,  following  the  axis  of  the  sesamoid;  then  the  cau- 
terization of  the  bone  and  its  cartilage,  in  imitation  of  what  is 
sometimes  done  in  punctured  wounds  of  the  foot.  Brauell  recom- 
mended as  a  usefiil  surgical  operation,  the  section  of  the  perforans 
tendon  in  the  metacarpal  region,  in  order  to  prevent  friction 
against  the  sesamoid  groove,  and  to  allow  an  easier  adhesion  be- 
tween the  tendon  and  the  bone.  But  it  is  to  be  feared  that  this 
section,  supposing  that  it  proves  successful,  might  so  weaken  the 
tendon  as  to  render  the  animal  unfit  for  fast  work. 

If  navicular  disease  should  be  accompanied  with  deviation  of 
the  wall,  and  contraction,  true  or  false,  the  treatment  will  be  that 


702  OPERATIONS    ON    THE    FOOT. 

of  this  affection  in  its  simple  form.  An  operation,  often  recom- 
mended, has  been  that  of  neurotomy,  upon  the  posterior  branches 
of  the  plantar  nerves,  repeated  at  intervals  of  at  least  fifteen  days, 
in  6rder  to  remove  the  lameness  wholly,  without  entirely  depriv- 
ing the  foot  of  the  sensibility  of  feeling.  Berger,  Brauell,  Bou- 
ley,  Gross,  Mandel,  and  others,  have  obtained  real  success  by  it; 
but  it  is  attended  with  serious  dangers ;  at  any  rate  the  benefit  is 
not  of  long  duration,  or  about  one  year.  The  animal  then  stumbles 
more  readily,  and  is  more  exposed  to  traumatic  lesions,  etc.,  and 
it  is  probable  from  this  cause  that  double  neurotomy  is  seen  to  be 
followed  by  softening  of  the  deep  parts  of  the  foot,  suppuration, 
sloughing  of  the  foot,  while  the  animal  has  previously  shown  no 
signs  of  pain.  Consequently,  neurotomy  is  an  operation  which 
finds  its  application  only  in  peculiar  and  exceptional  cases,  and 
animals  thus  operated  upon  remain  fit  for  light  work  only. 

QUITTOR. 

Synonyms. — Fesselgesehwur,  German ;  giarda,  Italian ;  gialarrs, 
Spanish ;  javart,  French. 

A  name  of  unknown  etymology,  by  which  old  hippiatrics  desig- 
nate various  affections  of  the  inferior  regions  of  the  legs  of  the 
horse,  donkey  and  mule,  and  even  of  bovines.  These  possess  the 
common  character  of  a  degeneration  of  a  portion  of  the  tissues, 
that  is  expelled  by  the  efforts  of  nature  under  the  form  of  a  slough 
{bourhilloti).  There  is  a  softening  of  the  mortified  structures, 
and  an  elimination  by  sujopuration.  In  several  old  works,  these 
sloughs  are  called  quittors  {javars),  and  this  name  has  been  ex- 
tended to  the  disease  itself. 

This  name  having  been  preserved  by  use,  notwithstanding  the 
efforts  of  Vatel  in  opposition,  we  shall  also  employ  it,  and  with 
Gu'ard,  recognize :  1st.  The  simple  or  cutaneous  quittor,  which 
is  only  the  furuncle  which  occurs  in  the  thickness  of  the  dermoid 
structm-e  nearest  to  the  coronary  band.  2d.  The  tendinous  quit- 
tor,  which  greatly  resembles  the  felon  of  man,  where  a  portion  of 
the  sub-cutaneous  cellular  tissue,  and  of  a  tendon  sloughs  out. 
3d.  The  sub-horny  quittor,  the  furuncle  of  the  cutidura  of  the 
coronary  band  itself,  the  slough  involving  the  superior  portion  of 
laminated  tissue.  4th.  The  cartilaginous  quittor,  or  the  limited 
caries  of  the  lateral  fibro-cartilage  of  the  os  pedis,  and  which  old 
writers  compounded  with  the  horny  quittor.     We  might  join  to 


DISEASES.  703 

those  the  furuncle  of  the  frog.  We  believe  it  useless,  at  present, 
to  enter  upon  a  general  consideration  of  quittor,  and  will  pro- 
ceed to  examine  the  pathological  phenomena  presented  by  each 
variety. 

A.  Cutaneous  Quittok.  —  This  is  a  simple  furuncle  of  the 
coronary  region  of  the  foot,  in  that  part  of  the  dermis  nearest  to 
the  coronary  band,  having,  however,  a  special  character  on  account 
of  the  extraordinary  thickness  and  inelasticity  of  the  dermis  of 
the  region  it  occupies,  the  result  being  a  kind  of  strangulation  of 
the  inflamed  tissue  beneath,  and  a  very  painful  compression.  It 
is  through  error  that  some  authors  have  designated  by  the  same 
name,  the  furuncle  of  the  canon,  of  the  fetlock,  and  of  the  co- 
ronet. 

The  hind  feet  are  more  subject  to  it  than  the  fore,  and  it  is 
more  frequent  at  the  heels,  at  the  flexure  of  the  fetlock,  though  it 
is  also  observed  on  the  sides  and  front  of  the  coronet,  in  which 
case  it  is  much  more  painful.  Cutaneous  quittor  has  also  been 
observed  in  bovines,  where,  however,  as  we  shall  see  as  we  pro- 
ceed, it  is  generally  complicated  with  the  tendinous  variety,  and 
becomes  a  true  felon. 

I.  Symptotns. — Cutaneous  quittor  is  characterized  by  an  in- 
flammatory tumor  or  swelling,  warm,  painful,  and  tense,  of  the 
coronary  region  of  the  foot,  the  color  of  the  skin  being  but  little 
changed,  if  it  is  dark,  but  if  the  skin  is  Hght  then  the  redness 
is  well  marked.  This  swelling  is  accompanied  with  a  diffused 
sedema,  extending  to  the  fetlock,  or  even  to  the  hock.  We  often 
find  angeioleucites,  or  rather  what  we  call  leucophlegmasise.  The 
lameness  is  generally  extreme,  and  the  animal  frequently  can 
scarcely  rest  on  the  diseased  leg.  The  j)ain  is  sometimes  so  great 
as  to  induce  general  fever  and  loss  of  appetite,  and  the  animal 
becomes  dull  and  depressed.  After  acquiring  certain  dimensions, 
the  tumor  shows  a  tendency  to  soften  at  its  summit,  its  base, 
however,  remaining  hard  for  a  considerable  time.  Rising  more 
and  more,  it  soon  ulcerates  at  a  point  from  which  flows  a  small 
quantity  of  bloody  pus,  followed  by  the  appearance  of  the  slough, 
{bourbillon).  An  abscess  is  now  formed  in  the  tumor,  which,  as 
it  opens,  carries  with  it  a  portion  of  the  skin,  sometimes  limited, 
at  others  measuring  from  four  to  ten  centimeters,  and  there  is  a 
slough  formed  of  the  subcutaneous  cellular  tissue  which  separates 
by  the  suppuration  with  the  portion  of  dead  skin.     This  comes 


704:  OPERATIONS    ON    THE    FOOT. 

out  by  degrees.  It  is  still  adherent  by  its  base  and  cannot  be 
pulled  out  with  the  forceps  unless  by  tearing  and  with  acute  pain, 
and  this  is  often  followed  by  slight  hemorrhage.  A  few  days 
later  it  will,  however,  become  entirely  loose,  and  in  its  place  there 
will  remain  a  cyhndroid  open  cavity  extending  through  the  tu- 
mor, from  its  summit  to  its  bottom,  and  from  this  a  deep  wound 
results,  foUowed  by  a  sero-bloody  secretion,  mingled  with  pus. 
As  soon  as  the  slough  has  taken  place,  or  when  it  begins,  the 
lameness  subsides,  as  well  as  all  the  other  phenomena  of  the  pain. 
The  wound  heals  up  rapidly  if  there  is  no  complication. 

Cutaneous  may  easily  be  complicated  with  tendinous  quittor  if 
the  disease  or  process  of  sloughing  of  the  mortified  tissues  ex- 
tends to  the  tendons  or  ligaments  of  the  region  involved.  This 
complication  is  specially  common  in  bovines,  where  cutaneous 
quittor  generally  gives  rise  to  more  sweUing  and  greater  suffering 
than  in  the  horse. 

The  quittor  has  quite  a  rapid  progress,  and  may  last  from 
eight  to  fifteen  days;  very  seldom  longer.  At  times,  it  seems  to 
be  a  single  furuncle ;  at  other  times,  there  are  several  existing  to- 
gether. Often  again,  they  come  in  succession,  the  first  one  treated 
being  soon  followed  by  others.  This  is  said  to  take  place  princi- 
pally when  the  diseased  part  remains  exposed  to  the  action  of  ir- 
ritating substances,  and  relapses  are  prevented  by  protecting  the 
part  from  the  effects  of  these  occasional  causes. 

II.  Pathological  Anatomy.  —  It  is  an  inflammation  of  the 
very  abundant  sub-cutaneous  cellular  tissue  of  the  region,  spread- 
ing from  a  starting  point;  the  inflamed  tissues  are  mortified  and 
becomes  gangrenous,  and  by  a  process  of  suppuration,  the  econ- 
omy attempts  to  eliminate  them.  The  slough  represents  more 
particularly  the  inflamed  cellular  tissue,  which  is  thickened,  and 
which  has  become  filamentous  and  hard  and  much  impregnated 
with  purulent  serosity. 

III.  Etiology. — Contusions  of  the  region,  bruises  and  punc- 
tured wounds  ai'e  quite  frequent  causes  of  cutaneous  quittor,  but 
it  may  also  take  place  without  evidence  of  determining  causes. 
Mud,  manure,  m-ine,  all  filth  in  which  animals  have  to  walk  or  re- 
main, are  also  considered  as  causes.  For  this  reason  the  disease 
is  more  common  in  the  fall  and  winter,  on  account  of  the  action 
of  cold  at  times,  and  frozen  mud.  It  is  also  more  frequent  in  cities 
than  in  the  country.     Ray  observes  that  the  mud  of  cities  is  al- 


DISEASES.  705 

ways  more  irritating  and  contains  mineral  substances,  especially 
lime,  alkalines,  and  salts,  and  other  substances.  The  gutters  of 
some  industrial  estabUshments  have  also  a  direct  irritating  action. 
D'Arboval  has  observed  that  the  mud  of  places  where  mineral 
springs  exist,  is  more  irritating,  as  also  are  calcareous  soils,  where 
cutaneous  quittor  is  more  frequent  than  in  any  other.  Common, 
large  horses,  notwithstanding  their  thick  skins — or,  rather  on  that 
account  and  on  account  of  the  haii*  which  covers  it — are  more 
commonly  affected  than  private  horses.  Towing  horses  are  much 
more  exposed  to  the  disease  than  those  otherwise  employed. 

IV.  Treatment. — As  a  first  direction,  during  the  course  of 
the  treatment  it  is  always  a  prudent  rule  not  to  work  the  animal 
and  to  keep  it  in  the  stable,  the  feet  being  kept  dry  on  a  good 
bedding.  An  internal  treatment  is  seldom  necessary  to  control 
the  general  symptoms ;  if  any  is  required,  ordinai-y  salines  will 
generally  be  sufficient.  It  is  necessary  to  assist  the  process  of 
suppvu'ation  of  the  abscess  by  emolients,  warm  baths,  j)Oultices  of 
flaxseed  or  of  marshmallows,  with  melted  lard,  api^lied  quite 
warm,  or  by  the  application  of  a  mixture  of  honey  and  bran  or 
flour.  We  have  ajipUed  a  coating  of  blister  ointment  to  the  tu- 
mor, covered  with  a  warm  poultice ;  the  maturing  efifect  is  then 
very  rapid.  It  is  often  necessary  to  lance  the  tumor  to  reduce 
the  i^ain  and  prevent  the  mortification  of '  a  large  piece  of  skin. 
This  operation  is  recommended  by  D'Ai-boval  and  H.  Bouley,  and 
is  sj)ecially  indicated  when  the  tumor  is  much  developed.  It  is 
then  important  to  incise  in  the  entire  thickness  of  the  dermis  and 
to  a  sufficient  length,  and  if  necessary  to  make  severel  parallel  in- 
cisions which  will  give  rise  to  a  copious  flow  of  blood.  In  this 
Imode,  the  parts  are  relieved,  the  pressure  of  the  tumefaction  is 
reduced  and  the  gangrene  diminished,  if  not  entirely  prevented. 
Jt  is  necessary — and  we  insist  on  this  point — to  incise  so  deeply 
•that  the  tumefied  skin  is  divided  in  its  entire  thickness.  We  have 
seen  blacksmiths  thus  operate  by  the  introduction  of  points  of 
cauterization  in  the  summit  of  the  abscess  ;  but  this  mode,  though 
facilitating  the  sloughing  of  the  strangvdated  part  and  reducing 
the  compression,  ought  not  to  be  preferred  to  the  incision  with  a 
sharp  instrument — cauterization  is  more  painful. 

When  gangrene  exists  and  the  abscess  is  open,  the  incision  is 
certainly  less  efficacious  than  at  the  outset,  but  it  is  not  for  that 
reason  useless,  as  it  relieves  the  pain  and  prevents  excessive  com- 


706  OPERATIONS    ON    THE    FOOT. 

pression.  We  do  not  by  it  attempt  to  loosen  the  slough,  which 
it  is  advantageous  to  have  detaching  loose  itself  vs^hen  it  holds 
only  by  its  base.  If  the  abscess,  once  formed,  is  slow  to  ulcerate, 
making  a  point  of  cauterization  is  a  good  way  to  stimulate  the 
escape  of  the  matter  of  the  slough.  This  mode  of  opening  pro- 
duces in  the  part  an  increase  of  vital  action  and  forms  a  sore  of 
benign  character,  which  falls  off  by  the  effect  of  the  suppuration 
formed  underneath,  and  which  is  nearly  always  followed  by  a 
comj^aratively  speedy  recovery.  To  obtain  this  radical  cure,  it 
remains  to  continue  the  use  of  the  ordinary  means  to  facilitate 
suppuration  and  bring  on  resolution.  If  the  wound  is  pal^  and 
covered  at  the  bottom  with  large  granulations,  it  must  be  dressed 
first  with  basilicon  ointment  and  afterward  with  alcoholic  liquids, 
as  spirits  of  camphor,  tincture  of  aloes,  or  simply  an  aromatic  in- 
fusion; at  times,  baths  of  sulphate  of  iron,  with  a  little  siilphate 
of  copper,  are  indicated ;  or,  when  the  wound  has  become  red,  the 
granulations  vascular  and  of  healthy  character,  a  simple  dressing 
of  cegyptiacum  ointment,  diluted  in  vinegar,  is  enough.  If  proud 
flesh  develops  itself,  it  must  be  cut  off.  It  is  important  to  have 
the  wound  covered  with  a  protecting  dressing,  which  must  be  re- 
newed daily  if  the  suppuration  is  very  abundant,  or  it  may  some- 
times be  left  on  for  two  days. 

B.  Tendinous  Quittok.  —  Synonym:  Hornwurne  (Germ.)  — 
It  is  the  nervous  quittor  of  hippiatres,  and  the  analogue  of  the 
felon  of  man.  It  is  again  a  furuncle,  different  from  the  preceding, 
only  because  instead  of  being  limited  to  the  skin  and  subcutane- 
ous cellular  tissue,  there  is  caries  of  a  portion  of  the  tendons 
(especially  the  flexors),  or  of  the  ligaments  of  the  region,  and  also, 
at  times,  necrosis  of  the  bone  with  synovitis  and  arthritis.  By 
extension,  though  we  think,  improperly,  the  name  has  also  been 
given  to  the  felon  of  the  region  of  the  cannon,  while  the  applica- 
tion ought  to  be  confined  to  that  of  the  digital  region,  situated  in 
the  fold  of  the  fetlock. 

The  quittor  may  be  suj)erficial  or  deep-seated  when  it  affects 
only  the  subcutaneous  cellular  tissue,  uniting  the  skin  to  the  ten- 
dons, or  whei'e  the  inflammation  extends  to  the  phalangeal  sheath, 
and  the  pus  accumulates  into  it.  Differing  from  cutaneous  quit- 
tor,  this  form,  generally  less  common,  is  more  frequently  seen  in 
the  anterior  than  the  posterior  extremities.  It  may  also  be  seen 
in  cattle. 


DISEASES.  707 

I.  Symptoms. — The  first  symptom  is  an  excessive  lameness, 
manifesting  itself  even  where  no  visible  change  exists  in  the  af- 
fected leg.  The  animal  evidently  suffers  great  pain,  while  his 
actions  do  not  aid  us  in  locaUzing  it  accurately,  though  the  foot 
is  always  examined  as  being  the  probable  seat  of  it,  the  animal 
raising  it  more  rapidly  than  the  other  from  the  groxmd,  and  rest- 
on  it  with  much  caution  and  hesitation.  After  from  two  to  five 
days,  a  phlegmonous  tumor  apxaears  at  the  coronet,  above  the 
heel.  It  is  extremely  warm,  and  much  more  painful  than  that  in 
cutaneous  quittor,  the  hoof  and  the  skin  preventing  the  free  de- 
velopment of  the  inflammation  by  strangulating  it.  The  foot 
almost  ceases  to  rest  on  the  ground,  but  is  flexed  and  raised  from 
it,  feeling  in  the  parts  being  very  painful.  The  swelling  of  the 
leg  extends  to  the  fetlock,  or  to  the  cannons,  and  even  to  the 
knee.  The  animal  has  more  or  less  fever,  and  when  there  is  a 
deep  quittor,  he  loses  all  his  appetite,  and  ordinarily  lies  down 
and  continues  in  the  recumbent  position. 

Generally,  much  time  is  required  for  the  phlegmon  to  assume 
the  character  of  an  abscess,  as  the  slough,  being  in  this  case  no 
longer  formed  by  the  cellular  tissue,  is  slower  to  define  itself. 
This  process  of  suppuration  is  not  so  well  localized ;  there  is,  on 
the  contrary,  a  kind  of  deep  abscess,  which  probably  becomes 
complicated  by  the  resistance  opposed  to  the  ulcerative  inflamma- 
tion by  the  aponeurosis  of  the  sheath  and  the  thickness  of  the 
skin.  However  this  may  be,  it  is  always  very  difficult  to  recog- 
nize the  presence  of  one  or  several  of  these  abscesses,  even  when 
they  form  in  the  subcutaneous  cellular  tissvie,  and  so  much  the 
more  if  the  purulent  gathering  is  deeply  seated. 

After  the  opening  of  the  abscess  and  exfoliation  of  the  slough, 
either  with  or  without  the  dropping  of  a  portion  of  the  skin, 
there  does  not  remain  the  simple  wound  of  the  cutaneous  quittor, 
but  on  the  contrary,  a  persistent  fistula,  running  down  a  necrosed 
point  of  the  tendons  or  of  the  fibrous  sheaths.  At  times,  almost 
from  the  outset,  we  may  observe  in  the  fold  of  the  coronet  numer- 
ous little  pimples,  which  terminate  in  as  many  deep  fistulse,  from 
which  ooze  a  more  or  less  thick  humor,  foetid,  puriform  and 
bloody.  In  frequent  cases,  the  disease  in  unaccompanied  with 
suppuration,  and  there  is  a  swelling,  more  or  less  hard,  with  a 
gradual  diminution  of  the  j^ain  and  other  inflammatory  symptoms. 
A  more  frequent  complication  is  the  suppurative  inflammation  of 


708  OPEKATIONS    ON    THE    FOOT. 

the  tendinous  sheaths,  or  even  of  the  digital  articulations.  There 
may  also  be  a  diffused  gangrene  with  separation  of  the  hoof  and 
purulent  infiltration  under  the  horny  box — periostitis,  and  caries 
of  the  cartilage.  This  is  the  deep  tendinous  quittor  in  the  most 
severe  form.  In  this  last  case,  especially  if  there  is  an  accumula- 
tion of  pus  in  the  tendinous  sheath,  the  tumor  is  very  painful,  the 
slightest  touch  giving  rise  to  the  manifestation  of  extremely  acute 
suffering,  the  hoof  being  constantly  raised  from  the  groxmd.  The 
fever  is  violent,  there  is  a  complete  anorexia,  and  the  exercise  of 
all  functions  is  more  or  less  disturbed.  The  compulsory  resting 
upon  the  healthy  legs  may  give  rise  to  swelling  of  the  hocks,  and 
even  to  laminitis. 

In  cattle,  tendinous  quittor  becomes  more  painful  than  in  the 
horse,  and  is  always  accompanied  by  a  swelling  which  may  extend 
to  the  knee.  Rumination  stops,  and  the  animal  endures  great  an- 
gmsh.  The  slough  is  followed  by  a  wound  of  varying  depth,  which 
often  exposes  the  diseased  articular  surfaces  of  the  phalanges.  If 
this  remains  too  long,  the  pus  may  affect  the  interdigital  ligament, 
complicate  the  disease,  and  even  make  it  incurable.  In  this  case, 
the  amputation  of  one  of  the  digits  may  sometimes  be  performed. 

II.  Progress,  Duration  and  Termination. — The  duration  is 
generally  protracted ;  the  disease  often  gives  rise  to  chronic  lesions 
difficult  to  remove.  This  will  be  easily  understood,  if  we  remem- 
ber that  the  region  affected  is  composed,  between  the  skin  and 
the  bones,  of  synovial  capsules,  ligaments,  tendons  and  aponeu- 
roses, more  or  less  cellular  tissue,  and  of  very  strong  nervous 
ramifications.  If  the  disease  is  not  very  deeply  seated  or  unilat- 
eral, complete  recovery  may  be  looked  for;  but  if  there  are 
chronic  lesions,  if  the  articular  surfaces  become  affected;  espe- 
cially if  particles  of  bones  are  sloughing,  if  the  animal  recovers  it 
will  be  but  imperfectly,  and  it  will  usually  be  accompanied  by 
anchylosis  of  the  joint,  and  diffused  gangrene  is  also  a  complica- 
tion to  be  looked  for. 

in.  Diagnosis. — We  said  at  the  beginning  that  tendinous 
quittor  is  a  very  obscm-e  disease ;  the  lameness  is  very  great,  but 
not  characteristic ;  in  proceeding,  we  referred  to  the  acute  local 
pains  at  the  side  of  the  tendinous  cord  of  the  cannon,  the  inflam- 
matory swelling,  the  increase  of  local  pains,  and  the  general  reac- 
tive fever. 

rV.  Prognosis. — It  is  a  very  serious  disease,  on  account  of 


DISEASES.  709 

the  possible  complications  and  bequelae.  The  loss,  or  the  deform- 
ity of  a  phalanx,  which  are  sometimes  armng  the  sequelae  of  the 
felon  of  man,  are  in  him  accidents  which  never  give  rise  to  serious 
comphcations,  or  are  quickly  forgotten,  while  in  the  horse  suck 
complications  are  equivalent  to  the  death  of  the  animal.  ^ 

V.  J^tiology. — The  causes  are  the  same  as  those  of  a  simple 
quittor,  which  is  complicated  with  the  tendinous  kind;  this  is  also 
observed  after  the  subcutaneous  abscesses,  frequently  resulting 
from  bruises,  or  even  from  punctered  wounds.  It  is  most  com- 
monly met  with  in  low-bred  horses,  and  Fisher  says  that  it  is 
more  frequent,  and  less  malignant,  in  young  than  in  adult  ani- 
mals ;  according  to  this  writer,  it  is  a  common  manifestation  of 
distemper.  Irritating  muds  favor  its  development  in  the  same 
manner  in  active  as  in  simple  quittor.  It  often  appears  without 
appreciable  causes. 

VI.  Treatment. — When  tendinous  quittor  is  superficial,  it  re- 
quires about  the  same  treatment  as  the  simple  kind,  except  that, 
in  this  case,  the  counter  openings  must  be  made  early  to  prevent 
the  sloughs,  migrations  of  the  pus  and  the  gangrene.  The  sur- 
geon must  not  forget  that  the  inflammation  in  this  affection  must 
ordinarily  terminate  by  suppuration,  and  he  must  bear  in  mind 
that  there  is  a  possibility  of  the  modification  of  the  inflamed  cell- 
ular tissue,  and  that  the  mortified  portion  of  that  tissue  must 
slough  out,  as  their  presence,  too  long  continued,  may  be  very 
dangerous.  The  general  indication  is  to  prevent,  as  much  as  pos- 
sible, the  accumulation  of  the  pus,  an  indication  which  will  be 
best  fulfilled  by  making  open^ings  for  its  escape,  even  before  the 
formation  of  the  abscess.  As  the  tissues  which  surround  the  pus 
are  very  resisting,  nature  will  not  be  able,  or  if  so,  only  with  great 
difficulty,  to  effect  the  expulsion  of  these  matters.  It  is  for  this 
reason  that  it  is  necessary  to  assist  her  operations  by  making  an 
opening  for  the  escape  of  the  pus  and  of  the  slough.  Tbe  opera- 
tion is  without  danger ;  but  if  it  is  not  jjerformed  in  good  time, 
lesions  will  be  likely  to  spread,  the  disease  cease  to  remain  a  local 
trouble,  and  the  life  of  the  animal  become  compromised. 

It  is  also  more  necessary  to  make  an  opening  when  the  puru- 
lent secretion  is  established,  for  in  this  case  it  is  important  to 
avoid  delay  and  to  facilitate  its  escape.  A  simjDle  longitudinal  in- 
cision, four  or  five  centimeters  long,  is  sufficient,  when  the  collec- 
tion lies  immediately  under  the  cutaneous  organ.     This  incision 


710  OPERATIONS    ON    THE    FOOT. 

must  involve  the  whole  thickness  of  the  skin,  as  far  as  the  ten- 
dons, and  should  be  made  in  the  middle  of  the  coronet  region,  as 
near  the  foot  as  possible.  It  gives  rise  to  an  abimdant  hemor- 
rhage, which  relieves  the  part,  and  warm  poultices  and  baths,  to 
accelerate  the  suppuration,  are  then  indicated. 

When  the  product  of  suppuration  has  passed  in  the  tendinous 
sheath,  a  longitudinal  opening  of  this  part  towards  the  most  de- 
pendent points,  is  indicated.  To  do  this,  a  canulated  directory  is 
introduced  to  guide  the  bistoury ;  when  the  incision  is  made,  the 
pus  flows  freely,  and  by  this  mode  the  large  blood  vessels  and  the 
various  ligaments  of  the  region  are  avoided  in  the  operation. 

Notwithstanding  the  incision,  or  if  the  suppuration  had  already 
accumulated  before  it  was  made,  the  pus  may  also  accumulate  in 
the  pouch  formed  by  the  tendinous  sheath  behind  the  tendons.  It 
is  then  very  difficult  to  prevent  its  collection  in  those  deep  joarts, 
and  it  may  extend  to  the  small  sesamoid.  It  is  because  the  pus 
cannot  run  toward  the  skin  that  it  filtrates  along  the  tendon.  It 
is  only  by  pressure  and  by  injections  that  the  indications  presented 
can  be  fulfilled.  After  making  free  incisions,  one  may  try  by  pres- 
sure to  remove  the  pus  accumulated  between  the  tendons  and  their 
sheaths,  following  it  by  cleansing  injections,  which  must  be  re- 
peated as  often  as  possible. 

The  wounds  which  remain  after  the  slough,  in  the  superficial 
tendinous  quittor,  and  that  which  follows  the  opening  of  the 
simple  or  multiple  abscesses  when  it  is  deeper,  are  always  charac- 
terized by  the  presence  of  fistulas  running  down  to  some  necrotic 
spot  of  the  tendons  or  of  their  sheaths.  For  these,  an  injection 
is  recommended  of  tincture  of  aloes,  tincture  of  iodine,  and  some- 
times of  Villate's  solution;  lately,  dressings  with  petroleum  or 
phenic  acid  have  been  used.  Phenicated  baths,  those  of  sulphate 
of  iron  and  lotions  of  permanganate  of  potash  have  also  proved 
useful.  At  times,  when  the  fistulas  are  persistent,  it  is  necessary, 
after  enlarging  them,  to  have  recourse  to  actual  cauterization  -with 
a  pointed  cautery  introduced,  while  at  a  white  heat,  down  to  the 
bottom  of  the  tract.  A  general  dressing  of  the  wound  follows, 
with  tincture  of  aloes,  sometimes  with  egyptiacum.  The  di*ess- 
ings  should  be  more  or  less  frequent,  according  to  the  quantity  of 
the  pus  discharged.  We  must  dress  it  until  the  wound  is  entirely 
healed,  and  it  must,  moreover,  be  carefully  watched  for  fear  of 
another  infiltration  of  pus,  or  the  formation  of  other  fistulas. 


DISEASES.  711 

Superficial  cauterization  is  necessary  in  order  to  remove  the 
induration  and  swellings  likely  to  follow,  and  to  stimulate  the 
resolution.  The  action  of  the  firing  may  be  stimulated  by  blister- 
ing, or  by  an  alterative  ointment  of  iodide  of  mercm*y,  of  sulphur, 
etc. 

C.  SuB-HoKNY  QuiTTOR. — This  is  the  inflammation  of  the  su- 
perior part  of  the  keratogenous  apparatus  of  the  cutidura;  or 
even  of  the  superior  parts  of  the  sensitive  lamina.  This  quittor 
is,  therefore,  located  under  the  horny  box,  and  is  more  like  the 
cartilaginous  kind,  which  old  hippiatrics,  and  especially  Solleysel 
and  Garsault,  describe  with  it.  It  generally  takes  place  on  the 
quarter,  and  more  seldom  at  the  toe,  or  at  the  mammae.  Some  - 
times  it  is  observed  at  the  heels,  but  it  is  then  of  small  conse- 
quence. 

I.  Sym.2ytonis.  —  The  lameness  is  very  great.  The  animal 
walks  on  three  legs,  and  there  is  strong  reactive  fever,  due  to  the 
excessive  pain — this  form  of  the  disease  being  more  painftd  than 
the  others,  in  consequence  of  the  pressure  of  the  horny  structure 
upon  the  inflamed  tissues.  At  the  origin  of  the  nail  a  warm  and 
very  painful  tumor  is  found;  the  foot  is  hot  and  the  hairs  staring- 
on  the  site  of  the  injury.  If  the  disease  has  existed  for  some 
time,  there  is  a  separation  of  the  hoof  at  its  origin,  due  to  a  sero- 
purulent  exudation,  and  under  the  hoof  suppuration  and  mortifi- 
cation of  a  more  or  less  extensive  portion  of  the  coronary  band, 
or  of  the  laminae  will  be  found.  The  suppuration  which  there 
exudes  varies,  being  in  rare  instances  blackish,  as  it  is  usually 
found  in  ti'aumatic  injuries  of  the  hoof;  or,  again,  it  is  white  and 
unctuous,  with  the  odor  of  decaying  cheese ;  while  more  commonly 
it  consists  of  a  bloody  or  greyish  matter,  mixed  with  pus. 

If  the  mortified  portion  is  not  deeply  seated,  so  that  the  slough 
can  take  place  readily,  the  quittor  is  quite  simple,  since  as  soon 
as  it  has  di-opped  off  there  is  a  well  marked  improvement.  The 
pain  then  ceases  almost  instantaneously,  and  the  wound  at  once 
progresses  toward  cicatrization.  But  it  is  not  rare,  even  when 
the  mortification  is  somewhat  superficial,  to  find  the  sub-ungueal 
suppiu^ation  extending  so  that  the  matter  runs  under  the  hoof, 
producing  at  times  more  or  less  serious  fistida,  or  a  separation  of 
the  sensitive  and  insensitive  laminae.  Girard  says  it  has  been  seen 
to  extend  downward  to  the  sole,  and  to  separate  it  from  the  vel- 
vety tissue.     The  deep,  sub-horny  quittor  may  be   complicated. 


712  OPERATIONS    ON    THE    FOOT. 

forward,  with  necrosis  of  the  tendon  of  the  extensor  muscle;  with 
the  inflammation  of  the  joint;  with  caries  of  the  os  pedis,  and 
even  to  assume  the  cartilaginous  form  of  the  disease  by  its  exten- 
sion to  the  cartilages  of  the  foot. 

After  the  recovery  of  the  sub-horny  quittor,  if  the  coronary 
band  has  been  mortified  in  its  entire  depth,  the  foot  may  present 
permanent  longitudinal  fissures,  or  seams,  or  transversal  grooves, 
presenting  evidences  of  the  existence  of  a  cicatricial  tissue  when 
the  quittor  was  in  progress. 

II.  Prognosis.  —  The  gravity  of  this  quittor  dei^ends  upon 
the  depth  of  the  disease.  "When  superficial  and  affecting  only 
the  surface  of  the  tissue,  it  is  easy  to  cure,  but  if  deeply  seated 
it  is  more  serious,  on  account  of  the  possibility  of  complications. 

III.  Etiology. — Bruises  and  violent  blows  are  the  ordinary 
causes  of  sub-horny  quittor.  It  is  commonly  due  to  overreach- 
ing, or  to  the  wounds  occurring  when  animals  are  wearing  long 
caulks,  as  in  winter.  The  irritating  effect  of  frozen  mud  has  also 
been  admitted  as  a  cause. 

IV.  Treatment.  —  The  sujjerficial  quittor  requires  a  simple 
treatment.  Emollient  baths  and  maturating  poultices  are  then 
indicated.  It  is  a  good  plan  to  thin  the  wall  with  the  rasjD  or  the 
sage  knife  over  the  whole  extent  of  the  furuncular  tumor  to  a 
height  of  about  two  fingers.  A  comjn-ess  of  chloroformed  oil, 
while  it  alleviates  the  pain,  is  also  indicated  to  soften  the  wall. 
It  frequently  becomes  necessary  to  puncture  the  tumor,  but  we 
j)refer  to  cauterize  it  with  a  pointed  iron,  following  the  cauteriza- 
tion with  a  poultice  of  honey  with  Venice  turpentine  or  camphor. 
Some  authors  recommend  astringent  baths,  as  oak  bark,  or  of 
sulphate  of  iron.  It  is  often  the  case  that  after  some  interval  fol- 
lowing sloughing  of  the  hoiirhillon,  the  wound  continues  to  dis- 
charge a  liquid  secretion,  which  is  an  evidence  that  there  is  a  ten- 
dency to  accumulation  of  matter  toward  the  lateral  cartilage,  or 
under  the  wall,  in  the  laminae ;  or  that  there  is  some  carious  spot 
existing.  In  the  first,  if  probing  horizontally,  a  cavity  is  de- 
tected, it  is  convincing  evidence  that  a  cartilaginous  quittor  is  in 
com-se  of  development ;  in  the  second  case,  the  pressure  and  col- 
lection of  the  matter  increases  the  inflammation  of  the  laminse, 
separates  the  wall,  and  complicates  the  disease,  necessitating  the 
operation  of  the  suh-ho7-ny  quittor. 

The  removal  of  the  portion  of  the  hoof  which  covers  the  lesion. 


DISEASES.  713 

must,  however,  include  more  than  tlie  purulent  center,  so  tnat  the 
diseased  tissues  may  be  well  exposed  and  the  suppurative  process 
detach  them  readily.  This  removal,  always  proportioned  to  the 
internal  lesions,  is  made  either  lengthwise,  following  the  direction 
of  the  horny  fibres,  or  crosswise.  In  that  case,  it  will  attack  only 
a  portion  of  the  wall  toward  its  point  of  union  with  the  skin. 
This  latter  method,  it  is  true,  requires  less  cutting,  but  it  has  sev- 
eral quite  serious  objections  and  often  necessitates  a  second  oper- 
ation. Even  in  cases  where  the  growth  of  the  granulations  can 
be  controlled,  and  where  a  good  return  of  the  horse  is  obtained, 
the  horse  only  recuperates  its  perfect  integrity  by  the  slow  growth 
downward  of  the  waU.  In  some  circumstances  the  operation  is 
completed  by  the  removal  of  a  portion,  or  even  of  the  entire  mass 
of  the  sole,  when  it  is  separated  from  the  velvety  tissue. 

The  removal  of  a  portion  of  the  wall  must  be  accomplished  in 
the  manner  which  will  be  indicated  for  cartilaginous  quittor,  in 
carefully  avoiding  the  injury  of  the  coronary  band  and  of  the 
podophyllous  tissue.  The  diseased  tissue  being  exposed,  all  that 
is  of  bad  appearance  is  removed,  the  carioiis  portion  being  freely 
taken  off.  An  ordinary'  dressing  of  oakum  with  diluted  alcohol, 
or  any  other  drug,  kept  in  place  with  a  light  shoe  or  slipper,  en- 
tire or  truncated,  as  the  case  requires,  is  then  applied. 

As  for  all  wounds  of  the  foot,  the  dressing  needs  only  to  be 
changed  when  the  pus  accumulated  under  the  oakum,  or  other 
peculiar  conditions  indicate  it.  It  is  true  that  changing  the  dress- 
ing is  an  effective  means  of  cleansing  the  wound,  but  it  has  the 
inconvenience  of  also  irritating  it,  and  especially  at  the  begin- 
ning may  tend  to  infeiTupt  the  natural  process  of  repair.  It  is  of 
advantage,  after  the  first  dressings,  to  change  them  as  infrequently 
as  possible.  In  this  way  hemorrhages,  which  may  always  be 
looked  for,  are  avoided.  This  is  a  point  of  the  first  importance. 
It  has  been  proved  that  even  in  operations  where  a  jDortion  of  the 
wall  has  been  removed,  a  dressing  left  on  for  from  fifteen  to 
twenty  days  without  removal,  was  followed  by  rapid  recovery,  the 
new  hoof  growing  under  the  oakum  without  suppuration.  It  is 
useless  to  probe  or  wipe  out  the  surface  of  the  wound.  On  the 
second  dressing,  that  is,  after  a  few  days,  the  parts  begin  to  be 
covered  with  numerous  white  points,  which  are  so  many  rudi- 
ments of  hoof.  These,  which  at  first  are  soft,  white,  and  isolated, 
gather  together  by  degrees,  and  first  unite  into  a  thin  layer,  soft 


714  OPERATIONS    ON    THE    FOOT. 

and  yellowish,  which  becomes  hard  and  thick ;  it  is  the  hoof  secret- 
ed by  the  laminse,  which,  httle  by  little,  unites  with  that  coming 
from  the  coronary  band.  Excessive  granulations  or  proud  flesh 
are  removed  in  the  ordinary  way. 

D.  Cartilaginous  Quittor. — Hufknorpelfister  (German) — 
{improperly  called  sub-horny  quittor^  by  Lafosse,  Jr.,  coronary 
quittor  of  Vitet^y^^ro  chrondritls  of  the  third  phalanx,  by  Vatei; 
sub-horny  cartilaginous  quittor  of  Girard ;  quittor  proper  of  Del- 
wart).  This  form  of  quittor  is  peculiar  to  solipeds,  they  being 
the  only  animals  which  have  fibro-cartilage  on  the  os  pedis. 


Fig.  523.— Cartilaginous  Apparatus  of  the  Hrrse's  Foot, 
o.— Lateral  flbro  cartilage.    6.— The  superior  border,    c— Its  posterior  border,    d.— 
Anterior  lateral  ligament,    e.— Flexor  tendons.    /.—Extensor  tendon.    g.—Os  pedis. 
A.— Retrorsal  process. 

These  fibro-cartilages  (Fig.  523)  are  two  pieces,  which,  with 
the  plantar  cushion,  complete  the  os  pedis  and  form  the  base  of 
the  heels,  each  representing  a  piece  flattened  sidewise,  a  parallelo- 
gram in  shape,  and  extending  posteriorly  to  the  cofiin  bone. 
Their  external  face  is  convex  and  pierced  with  foramina  for  the 
passage  of  veins,  and  slightly  overlies  the  surface  of  the  bone  of 
the  foot.  It  is  separated  from  the  skin  by  a  very  rich  vascular 
plexus.  The  internal  face,  concave,  is  hollowed  by  vascular 
grooves,  and  covers  (forward)  the  articulation  of  the  foot  and  the 
cul-de-sac  of  the  synovial  sac  which  protrudes  between  the  two 
lateral  hgaments  of  that  joint.  Downward  and  backward  it  is 
united  to  the  plantar  cushion,  either  by  continuity  of  tissue,  as 


DISEASES.  715 

near  the  inferior  border,  or  by  fibrous  bands  running  from  one  to 
the  other.  The  superior  border,  either  convex  or  straight,  is  thin 
and  separated  from  the  posterior  by  an  obtuse  angle  in  front  of 
which  it  presents  a  deep  notch  for  the  passage  of  the  blood  ves- 
sels and  nerves.  The  inferior  border  is  attached,  forward,  to  the 
basilar  and  retrosal  processes  of  the  os  pedis.  Behind  this  it  re- 
flects inward,  to  continue  to  the  inferior  face  of  the  plantar  cush- 
ion. The  posterior  border,  obHque,  backward  and  downward,  is 
slightly  convex  and  unites  with  the  preceding.  The  anterior 
border,  oblique  in  the  same  direction,  is  more  intimately  united  to 
the  anterior  lateral  ligament  of  the  articulation  and  can  be  sepa- 
rated from  it  only  by  artificial  dissection.  It  sends  upon  this 
ligament  and  upon  the  anterior  extensor  of  the  phalanx,  a  fibrous 
extension,  which  unites  with  that  of  the  opposite  side. 

In  their  structure,  the  fibro-cartilages  comprehend  a  mixture 
of  fibrous  and  cartilaginous  tissue,  a  mixture  which  is  far  from 
being  homogeneous  and  even  in  the  various  parts.  The  more  it 
is  examined  forward  and  near  the  base,  the  more  its  substance  is 
seen  to  resemble  that  of  cartilages  proper,  being  white,  flexible, 
brittle,  and  homogeneous.  Toward  its  posterior  part  it  loses  its 
character  of  homogenity,  becomes  less  brittle  and  presents  in  its 
thickness  a  greater  amount  of  fibrous  texture.  More  posteriorly 
again,  the  fibro-cartilaginous  structure  is  more  marked.  By  close 
attention  it  seems  to  show  cartilaginous  nuclei,  isolated,  and  sur- 
rounded with  an  entirely  fibrous  substance ;  and  again,  at  its  pos- 
terior extremity  it  becomes  fibro-greasy  with  much  cellular  tissue 
and  unites  with  the  plantar  cushion.  The  vitality  of  the  cartilage 
is  in  inverse  ratio  with  its  density  and  consequently  is  greater  in 
its  posterior  part  than  toward  the  base  and  its  anterior  extremity. 
This  fibro-cartilage  may  easily  and  more  or  less  completely  be- 
come ossified ;  old  horses  are  those  which  most  commonly  present 
this  condition,  and  draught  horses  are  more  subject  to  it  than 
those  used  to  the  saddle.  It  assumes  various  forms.  At  times  it 
occupies  the  entire  extent  of  the  cartilage,  and  at  others  only  at  its 
base ;  sometimes  the  external  surface  is  ossified,  while  the  internal 
remains  in  its  normal  structure ;  then  again,  the  ossification  exists 
only  anteriorly  while  the  posterior  is  cartilaginous,  and  it  more 
rarely  happens  that  the  process  consists  in  bony  lamellae,  which, 
starting  from  the  base,  spread  toward  various  points  of  its  cir- 
cumference. 


716  OPERATIONS    ON    THE    FOOT. 

These  fibro-cartilages  are  generally  more  developed  in  the  an- 
terior than  the  posterior  extremities.  They  also  j)resent,  in  one 
foot,  this  slight  difference,  that  the  internal  stands  a  little  higher 
than  the  external. 

Cartilaginous  quittor  is  a  serious  affection,  characterized  by 
the  partial  caries  of  one  of  the  fibro-cartilages ;  it  is  a  partial  gan- 
grene whose  character  is  to  slowly  spread  into  the  cartilaginous 
structure  upon  which  it  starts.  To  be  treated  with  success,  it  re- 
quires a  very  regular  attendance,  and  often  an  operation,  which 
consists  in  the  removal  of  the  cartilage.  Sometimes  this  opera- 
tion is  indispensable,  and  its  study  is  interesting,  especially  be- 
cause, though  not  as  commonly  performed  as  at  the  beginning  of 
this  century,  it  is  one  which  requires  a  high  degree  of  surgical 
skill  for  its  success. 

I.  Symptoms. — A  division  has  been  made  of  an  acute  and 
chronic  form  of  this  disease.  Under  the  first  name,  is  considered 
the  earlier  period  of  the  affection,  that  in  which  there  is  inflam- 
mation of  the  cartilage  and  painful  swelling  of  the  part,  and  when 
the  caries  or  necrosis  of  the  fibro-cartilage  is  not  yet  estabhshed; 
or  if  there  is  a  wound,  when  it  does  not  yet  granulate,  and  the 
suppuration,  if  it  exists,  is  very  slight.  Chronic  javart  would  be 
that  in  which  the  partial  and  progressive  mortification  of  the 
fibro-cartilage  exists ;  for,  as  Kenault  has  said,  it  is  the  ordinary 
termination  of  fibro-chondritis. 

When  free  from  serious  compHcation,  the  disease  is  generally 
accompanied  with  but  little  lameness  ;  sometimes  there  is  almost 
none,  and  animals  can  be  kept  at  work,  esj)ecially  at  a  slow  gait; 
but  if  made  to  trot,  the  horse  will  show  lameness.  It  is  especially 
when  the  quittor  exists  in  the  posterior  parts,  that  the  inflamma- 
tion and  the  pain  are  not  excessive,  because  there  is  then  an 
abundance  of  soft,  fatty  tissue.  But  when  the  caries  is  more  for- 
ward, and  is  situated  more  deeply,  in  a  point  nearer  the  articular 
surface,  the  lesion  then  affects  the  fibrous  tissues  and  the  pain  is 
greater.     It  is  sometimes  excessively  acute. 

Upon  the  lateral  part  of  the  coronet,  toward  the  heels  or  the 
quarters,  more  or  less  tumefaction  appears,  more  or  less  painful, 
according  to  the  duration  of  the  disease,  and  in  this  case  more 
or  less  indurated.  In  the  centre  there  exists  a  granulating  fistu- 
lous wound.  There  are  one  or  several  fistulfe  (Figs.  524,  525,  526) 
whose  openings  show  granulations,  bleeding  easily,  their  course 


DISEASES. 


717 


FIGS  s'^'.'STs^^rtnagTnon.Qnlttor.    Various  Spots  of  NecrOBlB. 


718  OPEKATIONS    ON    THE    FOOT. 

always  forward,  running  at  times  in  straight  lines,  at  others  ir- 
regularly. The  tracts  frequently  communicate  and  discharge  a 
granular,  serous  and  thin  pus,  of  pale  greyish  color,  generally 
odorless,  or  slightly  sanious,  containing  greenish  particles,  which 
are  but  pieces  of  diseased  fibro-cartilage.  The  pus  dries  up  on 
the  surface  and  adheres  to  the  hoof  and  to  the  hair,  and  some- 
times irritates  the  surface  of  the  skin.  If  one  of  these  fistula  be- 
come cicatrized,  a  fluctuating  tumor  soon  appears,  close  to  it, 
which  rapidly  ulcerates,  and  then  gives  rise  to  another  fistula.  If 
the  disease  is  quite  old,  the  hoof  of  the  quarter  corresponding  to 
the  necrosed  cartilage,  loses  its  perioplic  band,  becoming  rough, 
ramy  and  cracked,  and  the  wall  is  thickened,  because  the  irritation 
of  the  coronary  band  has  stimulated  its  growth.  This  change  in 
the  condition  of  the  wall  varies  with  the  length  of  time  the  dis- 
ease has  existed,  and  consequently,  it  indicates  its  duration  quite 
accurately,  when  one  remembers  that  the  hoof  grows  downward 
about  one  centimeter  in  each  month. 

"When  cartilaginous  quittor  is  the  sequelae  or  complication 
of  the  suppurative  corn,  of  a  punctured  wound  by  a  nail  of  the 
shoe,  or  any  other  affection  of  the  foot,  the  symptoms  proper  to 
these  diseases  are  first  observed,  though  the  lameness  is  greater, 
and  the  fistulse  of  the  quittor  is  evident.  Often,  however,  this, 
instead  of  being  external  and  on  the  coronet,  is  situated  at  the  in- 
ferior part  of  the  foot,  at  the  internal  face  of  the  inferior  border 
of  the  wall,  upon  the  sole,  and  sometimes  connected  with  the 
wound  of  some  of  those  affections  of  the  foot. 

II.  Pathological  Anatomy. — When  one  examines  the  cartil- 
age affected  with  the  necrosis  proper  of  quittor,  he  always  finds 
lesions  in  proportion  to  the  intensity  and  the  age  of  the  disease. 
It  is  seldom,  however,  that  the  portions  of  the  cartilage  which 
have  undergone  the  green  degeneration,  constituting  the  caries, 
reaches  more  than  one  centimeter  in  extent ;  they  have  the  form 
of  a  small  plate,  of  a  green  color,  ordinarily  elongated,  and  adhe- 
rent to  the  healthy  parts  of  the  cartilage  by  one  of  its  extremities, 
that  which  is  more  forward  and  the  deepest.  Others  have  com- 
pared it  to  the  green  growth  of  a  seed  in  germination.  The 
points  of  the  fibro-cartilage  which  are  in  immediate  contact  with 
the  carious  portion,  have  also  a  slightly  pale  greenish  hue.  These 
are  already  diseased ;  there  is  already  a  beginning  of  necrosis ;  in 
the  remainder  of  its  extent  the  exfoliation  is  separated  from  the 


DISEASES.  719 

cartilage  by  a  reddish,  soft  tissue,  which  also  lines  the  inside  of 
the  fistulous  tract.  This  fistula,  which  extends  from  the  necrosed 
spot  to  the  skin,  is  but  the  hollow  tract  left  by  the  diseased  proc- 
ess upon  the  cartilage,  while  gradually  destroying  its  substance. 
Always  Hned  with  a  pseudo-mucous  membrane,  by  a  true  pyro- 
genic  apparatus,  the  fistula  is  often  narrow,  sinuous,  irregular  in 
its  coui'se  and  extent,  especially  if  the  disease  is  of  some  standing. 

Kenault,  and  after  him  Lafosse,  have  mentioned  a  special  al- 
teration of  the  fibro-cartilage  which  is  sometimes  met,  and  which 
Lafosse  looks  upon  as  a  step  toward  recovery.  It  is  a  softening 
of  the  tissue,  anatomically  characterized  by  a  loss  of  the  consist- 
ency of  the  cartilage,  resembling  the  case  of  the  cellular  tissue 
becoming  indurated,  or  that  of  bones  deprived  of  their  earthly 
salts  after  soaking  in  weak  acids ;  its  yellowish  color  is  then  char- 
acteristic. It  may  be  noticed  during  life,  and  is  recognized  by  a 
softening  in  the  region  of  the  cartilage,  which  then  yields,  giving 
easily  to  the  pressure  of  the  finger;  besides  this,, a  probe  intro- 
duced into  the  fistulous  tract  readily  penetrates  into  the  softenetl 
substance.  But  the  true  way  to  diagnosticate  this  change  con- 
sists in  raising  the  coronary  band  or  after  thinning  the  wall ;  then 
one  will  see  and  may  feel  the  true  nature  of  the  transformation. 
Lafosse  adds  that,  in  presence  of  this  alteration,  the  removal  of 
the  cartilage  is  no  more  necessary,  for  then  the  cicatrization  is 
readily  obtained  by  stimulating  the  sloughing  of  the  necrosed  tis- 
sue or  by  removing  it. 

With  cartilaginous  quittor  there  is  always  plastic  infiltration 
of  the  cellular  tissue  surrounding  the  cartilage.  Very  often  the 
wall  of  the  synovial  capsule  of  the  articulation  of  the  foot  is  some- 
what thickened,  and  in  that  case  there  is  less  risk  of  injuring  it 
during  the  operation. — (Key.) 

III.  Progress,  Duration  and  Termination. — Left  to  itself, 
the  caries  of  the  fibro-cartilage  may  last  for  a  long  time,  through 
difficulty  in  determining  its  true  nature.  Spontaneous  cure,  how- 
ever, is  not  impossible,  as  Eenault  proved  it,  and  as  many  practi- 
tioners have  seen  it,  especially  in  young  and  healthy  subjects, 
when  the  disease  is  mild  at  its  outset  and  effects  parts  of  the  or- 
gans where  the  fibrous  element  predominates,  as  in  the  posterior 
portion  of  the  cartilage.  This  fortunate  result  follows  the  slough- 
ing of  the  "  bourbillon "  which  makes  its  appearance  under  the 
shape  of  a  greenish  particle. 


720  OPERATIONS   ON    THE    FOOT. 

But,  ordinarily,  the  disease  progresses  slowly,  destroying  the 
cartilage  by  degrees,  and  the  diseased  process  ceases  only  when 
the  caries  has  reached  the  ligament  of  the  joint,  which  it  some- 
times also  attacks.  The  tissue  of  the  fibro-cartilages  has  not 
the  force  of  reaction  possessed  by  other  inflamed  structures,  and 
which  is  so  well  marked  in  cellular  tissue.  A  process  of  suppura- 
tion, such  as  rapidly  eliminates  the  mortified  structure,  cannot 
very  readily  take  place  in  it,  and  when  by  natural  forces  the  cari- 
ous spot  is  eliminated  and  pushed  outward,  the  surrounding  tis- 
sues are  most  commonly  already  affected.  These  undergo  the 
same  alterations,  and  are  eliminated  in  the  same  manner  until 
the  entire  cartilage  is  destroyed.  This  process  of  caries  by  repe- 
tition may  last  a  year. 

In  its  progressive  stage,  the  disease  may  spread  to  surround- 
ing parts,  such  as  the  os  pedis,  the  plantar  aponeurosis,  the  liga- 
ment of  the  joint,  or  the  sesamoid  sheath,  all  of  which  may  be- 
come the  seat  of  inflammation.  They  are  diagnosticated  by  the 
greater  pain  and  more  marked  lameness,  symptoms  which  are 
comparatively  light  in  the  simple  necrosis  of  the  cartilage. 

Finally,  as  a  possible  complication  of  cartilaginous  quittor,  one 
may  observe  an  entire  emaciation  of  the  animal,  an  alteration  of 
the  fluids  due  to  a  putrid  or  purulent  infection;  some  authors 
claim  to  have  even  seen  glanders  and  farcy  follow  it ;  this  is  inad- 
missible. 

IV.  Diagnosis.  —  Cartilaginous  quittor  is  recognized  only 
when  there  is  a  wound  from  which  escapes  the  product  of  the 
suppuration  and  of  the  necrosis.  This  pus  has  nothing  charac- 
teristic, notwithstanding  what  has  been  said.  If  it  is  thinner 
than  that  of  a  simple  solution  of  continuity  of  the  region,  or  that 
of  simple  quittor ;  if  it  is  less  foetid  than  that  of  bony  caries,  it 
has,  however,  of  itself  some  sjiecial  characters,  varying  according 
to  the  subject  and  the  degree  of  the  disease,  and  especially  resem- 
bhng  much  that  of  sub-horny  quittor.  If  the  escape  of  the  pus  is 
slow,  and  it  is  desired  to  carefully  examine  it,  a  simple  pad  of 
oakum,  kept  by  a  few  turns  of  bandages  on  the  fistulous  opening, 
will,  when  removed,  give  a  sufficient  opportunity  to  recognize  its 
nature. 

The  probing  will  often  assist  in  distinguishing  the  cartilagin- 
ous from  the  simple  or  sub-horny  quittor.  In  these  last,  the  fis- 
tula is  less  profound,  and  does  not  reach  the  thickness  of  the 


DISEASES.  721 

cartilage ;  but,  as  in  cartilaginous  disease,  the  fistvila  is  often  sin- 
uous, it  is  better  to  use  a  soft,  flexible  instrument,  such  as  a  fine 
probe  made  of  lead.  The  injection  of  liquid  may  take  the  place 
of  the  probing ;  injected  in  a  superficial  tract,  it  returns  outward 
directly,  while  in  deeper  and  irregular  fistulae,  it  will  penetrate 
more  readily.  The  induration  of  the  coronet,  the  rough  and  ramy 
appearance  of  the  hoof  of  the  quarter  corresjDOuding  to  the  fis- 
tula, indicate  generally  a  necrosis  of  the  fibro-cartilage ;  these 
characters  are  missing  in  the  furuncle. 

V.  Jr*rognosis. — In  consequence  of  the  tenacity  of  the  disease, 
this  form  of  quittor  is  always  serious ;  though  this  gravity  has,  in 
our  days,  greatly  diminished,  on  account  of  the  means  of  treat- 
ment now  in  use,  which  were  unknown  some  thirty  years  ago. 
Now,  this  affection,  which  was  considered  by  all  hippiatrics  as  al- 
most incurable  and  which  more  recently  was  treated  by  an  opera- 
tion which  rendered  the  animal  unfit  for  work  for  several  months, 
can  in  the  majority  of  cases  be  cured  in  about  fifteen  days. 

The  prognosis,  however,  varies  and  depends  on  the  comj)lica- 
tion.  "When  there  is  caries  of  the  ligaments,  inflammation  of  the 
articulation  of  the  foot,  or  of  the  sesamoid  sheath,  the  extirpation 
of  the  cartilage  itself,  done  with  the  greatest  dexterity,  is  not 
even  a  warranty  of  recovery.  It  remedies  only  the  necrosis  of 
the  cartilage,  but  leaves  the  other  diseased  processes  to  progress 
in  such  a  manner  that  the  animal  remains  worthless  if  he  has  not 
to  succumb  to  them.  The  pain  is,  besides  the  other  signs,  one  of 
the  most  important  points  to  consider :  very  acute,  it  is  generally 
a  discouraging  omen,  and  points  to  the  existence  of  serious  com- 
pUcations. 

VI.  Etiology. — Heavy  draught  horses  are  more  frequently  af- 
fected, on  account  of  their  peculiar  work.  The  most  common 
cause  is  a  bruise,  a  blow,  a  burn,  a  prick,  any  wound  exposing  the 
cartilage;  it  is  most  common  in  horses  drawing  trucks  loaded 
with  stones,  which  may  drop  on  their  feet  and  crush  the  fibro- 
cartilage.  The  same  cause  exists  for  horses  working  in  extensive 
works  of  buildings,  in  the  construction  of  railroads,  and  in  the 
shops  of  mechanic  construction. 

Owing  to  these  conditions,  it  is  also  more  common  in  large 
cities  than  in  the  country,  and  more  frequent  in  stony  and  tem- 
porary roads  than  in  those  which  are  smooth  and  flat.  Flat  feet, 
with  low  heels,  are  more  exposed  than  others,  as  well  as  those 


722  OPERATIONS    ON    THE    FOOT. 

whose  lioofs  are  soft.  Quittor  is  more  frequent  in  the  fore  than 
the  hind  feet,  the  fibro-cartilages  of  the  fore  feet  being  more  de- 
veloped and  more  flexible,  and  because  their  heels  are  generally 
lower  than  in  the  hind  legs.  In  some,  it  is  more  common  on  the 
internal  than  the  external  quarters,  while  with  us,  it  has  been  the 
contrary. 

It  is  often  a  comphcation  of  suppurative  com ;  of  piinctured 
wounds  of  the  foot,  of  canker,  of  simple  and  sub-horny  quittor,  of 
grease,  etc.,  which  are  then  the  determining  causes  of  the  disease. 

VII.  Treatment. — "VMien  the  disease  is  recent  and  the  quittor 
acute,  and  antiphlogistic  treatment  may  be  attempted  and  resolu- 
tion looked  for,  baths  and  emollients  are  generally  beneficial.  A 
good  blister  has  sometimes  proved  advantageous,  and  when  it  is 
used,  hmited  suppuration,  with  the  formation  of  a  simple  slough, 
may  take  place. 

If  necrosis  is  well  established,  it  is  an  indication  of  the  neces- 
sity of  a  recourse  to  more  energetic  treatment,  in  which  case  sev- 
eral measures  are  recommended,  including  the  actual  and  poten- 
tial cautery  and  the  removal  of  the  cartilage. 

In  actual  cauterization,  the  necrosed  spot  is  destroyed  by  a 
cautery  brought  to  a  white  heat,  apjplied  directly  ujDon  it,  after  it 
has  been  exposed  by  a  free  incision.  It  is  a  simple  treatment,  and 
one  that  has  been  successful  in  cases  of  posterior  necrosis  where 
much  fibrous  tissue  was  diseased,  and  principally  in  young  and 
weU-conditioned  animals  (Lafosse,  Sr.,  Girard,  Vatel,  Mangin, 
Kenault).  Still,  this  treatment  not  only  often  fails,  but  may  even 
become  a  means  of  irritation  of  the  fibro-cartilage,  and  cause  an 
extension  of  the  necrosis.  (Hurtral,  D'Arboval,  Lafosse).  In  our 
day,  this  treatment  is  almost  entirely  ignored  by  good  practition- 
ers, and  the  potential  cautery  more  generally  adopted. 

This  had  already  been  employed  by  hippiatrics.  Solleysel 
principally  recommended  the  use  of  corrosive  sublimate  mixed 
with  aloes ;  Girard,  Barreyre  and  Bernard  also  mentioning  it. 
English  veterinarians  recommended  their  use  very  strongly. 
(White,  Blaine,  Kiding,  etc.).  These  practitioners  all  used  the 
sohd  caustic,  either  in  the  form  of  trochiscus  or  in  powder,  and  if 
they  obtained  good  results,  it  requii-ed  a  much  longer  time  than 
that  required  in  our  day  by  the  use  of  the  liquid  forms  of  caustics 
which  are  at  our  command.  With  the  solid  form,  the  action  was 
of  limited  extent,  and  scarcely  more  effective  than  that  obtained 


DISEASES. 


723 


by  the  actual  cautery;  moreover,  they  frequently  injured  the 
healthy  structures  by  irritating  them  and  increasing  the  inflam- 
mation, and  thus  resulting  in  serious  complications. 

As  we  have  said,  Hquid  caustics  are  largely  used  to  arrest  the 
spread  of  the  caries;  they  modify  the  process  of  decomposition, 
dry  up  the  suppuration  and  stimulate  the  tissues  w^ithout  injuring 
the  healthy  structures.  This  mode  of  treatment  must  be  credited 
to  Mariage,  who  in  1847  established  the  unfailing  efficacy  of  re- 
peated injections  of  Villate's  solution;  one  of  sulphate  of  copper 
and  sulphate  of  zinc,  64  grammes  of  each  in  1  liter  of  vinegar, 
and  decomposed  by  125  grammes  of  Goulard's  extract.  It  is 
really  simply  a  solution  in  vinegar  of  acetate  of  copper  and  zinc, 
holding  sulphate  of  lead  in  suspension.  Villate  himself  had  al- 
ready used  his  solution  with  success  by  injecting  it  in  cartilagin- 
ous quittor  as  early  as  1829,  since  which  time  Burgniet,  Verrier, 
Sr.,  Collignon  and  others  have  recognized  the  benefit  of  liquid 
€Scharotics  in  the  treatment  of  the  same  disease.  Villate's  solu- 
tion is  not  a  specific,  and  cartilaginous  quittor  has  been  cured  by 
the  injection  of  tincture  of  sublimate  with  solution  of  nitrate  of 
silver  (Bernard),  with  the  perchloride  of  iron,  chloride  of  copper, 
sulphate  of  copper  and  zinc,  nitrate  of  lead,  more  or  less  concen- 
trated mineral  acids,  and  especially  the  Eabel  water  (Collignon). 

It  is  difiicult  to  say  which  is  the  more  useful  of  these  drugs 
and  which  has  been  more  successful.  Success  has  also  been  ob- 
tained with  injections  of  tincture  of  iodine,  phenic  acid  and  even 
petroleum.  It  is  less  the  nature  of  the  drug  that  insures  the  ef- 
fect than  the  mode  of  using  it.  We  ought  also  to  say  that,  ad- 
vantageous as  this  mode  of  treatment  is,  it  is  not  infallible,  though 
Mariage  and  others  so  consider  it.  It  is  not  to  be  preferred  to 
the  extirpation  of  the  cartilage,  an  operation  which  proves  suc- 
cessful when  all  other  means  have  failed. 

To  obtain  a  cure  by  the  use  of  liquid  applications  it  is  essen- 
tial to  make  injections  every  day,  and  even  several  times  daily. 
These  are  made  with  a  syringe,  carefuUy  adapted  in  resjoect  to 
size,  with  a  small  canula.  The  injection  must  be  pushed  well  in, 
but  must  be  allowed  to  escape  freely  after  coming  in  contact  with 
all  the  diseased  sui-faces  which  it  is  designed  to  modify.  To  effect 
this,  it  becomes  necessary,  as  the  fistulse  are  sometimes  very  nar- 
row, and  even  irregular,  to  enlai'ge  them,  or  to  make  counter 
openings.     Mariage  had  originally  insisted  that  these  jprecautiona 


724  OPERATIONS    ON    THE    FOOT. 

were  essential  to  the  success  of  tlie  treatment.  H.  Bouley  and 
Viseur  also  strongly  insisted  upon  the  same  point,  viz.,  that  of  en- 
larging the  fistula  in  order  that  the  liquid  should  not  be  allowed 
to  remain  at  the  bottom  of  the  fistulous  tracts,  by  which  all  possi- 
bility of  the  extension  of  the  disease  from  that  cause  might  be 
avoided.  These  enlargements  of  the  fistulse,  or  counter  openings, 
close,  however,  very  rapidly;  as  a  remedy  to  which,  Hivernat  has 
suggested  the  introduction  into  the  tracts  of  little  wedges  of  wood 
pointed  like  pencils,  for  the  purpose  of  lacerating  the  walls  of  the 
fistula,  followed  by  the  insertion  in  them  of  small  setons,  moist- 
ened with  Villate's  solution.  Guerrapain  introduced  a  fine  meche 
of  oakum,  a  seton  in  the  tract,  by  means  of  a  curved  needle.  If 
the  fistula  runs  downward  its  bottom  is  under  the  wall,  and  he 
thins  this  down  and  makes  a  counter  opening  through  the  hoof 
thus  thinned.  This  seton  j)revents  the  closing  of  the  counter 
opening,  and  enables  the  operator  to  push  through  the  injection 
regularly. 

Other  precautions  are  also  necessary.  One,  especially,  is  rest. 
The  animal  must  not  be  put  to  work.  Lafosse  says  that  these 
liquid  caustics  act  with  regularity  and  cure  with  certainty.  A  bar 
shoe,  not  pressing  on  the  diseased  quarter,  is  also  useful.  Emol- 
lient poultices  are  sometimes  necessary  after  the  injection,  to 
diminish  the  irritation.  Mariage  also  recommends  them.  If  the 
fistula  extends  under  the  coronary  band,  or  the  podophyllous  tis- 
sue, it  becomes  necessary  to  thin,  or  to  remove  altogether,  the 
hoof  of  the  diseased  quarter. 

After  fifteen  days  of  this  treatment,  the  exfoliation  often  takes 
place,  and  recovery  follows.  Often,  however,  twice  this  length  of 
time  is  necessary.  After  the  first  eight  days  the  pus  becomes 
more  abundant,  white  and  laudable ;  the  tumor  softens  and  dimin- 
ishes, as  the  pain  subsides.  Later,  the  injections  penetrate  with 
greater  difficulty,  which  is  a  good  sign.  The  injections  constantly 
attack  the  germ  of  the  disease  and  leave  it  without  chance  to  re- 
form or  to  spread;  the  gangrenous  structure  which  develops  in 
the  cartilage  is  changed  into  an  inert  substance;  the  pyogenic 
membrane  of  the  fistulous  tract  is  stimulated;  the  process  of 
granulation  becomes  more  rapid ;  the  wound  becomes  more  and 
more  healthy,  and  the  diseased  process  ceases.  If,  however,  it 
continues,  the  wound  changes  its  character,  large  granulations 
develop  themselves,  and  in  their  center  the  openings  of  the  fistu- 


DISEASES.  725 

Ions  tracts,  -vrhicli  open  on  the  cartilage,  make  their  appearance. 
At  times  the  woimd  closes ;  but,  after  a  short  interval,  opens  again, 
or  another  forms  at  another  point.  There  is  then  a  repetition  of 
the  same  course  of  treatment  by  caustic  apphcations — but  gener- 
ally this  indicates  a  complication,  and  suggests  the  propriety  of 
an  operation.  The  injections  are  generally  successful,  however, 
and  most  certainly  so  if  the  caries  occupies  the  posterior  parts  of 
the  cartilage.  They  may  even  succeed  in  the  anterior  parts,  when 
the  animal  is  young  and  of  good  constitution.  But  if  the  cartil- 
age has  already  become  partly  ossified,  the  caustic  is  irregular  in 
its  action,  and  the  result  becomes  doubtful.  If  the  caries  is  deep 
and  extensive,  and  especially  if  the  necrosis  extends  through  and 
through  to  a  point  corresponding  to  the  synovial  capsule  of  the 
articulation  of  the  last  phalanx;  or  if  the  necrosis  exists  on  the 
internal  face  of  the  cartilage,  where  it  covers  that  structure,  then 
the  repeated  injections  of  Villate's,  or  of  any  other  caustic,  may 
be  followed  by  serious  complications.  An  old  or  comj)licated  caries 
will  offer  an  increased  resistance  to  the  treatment  by  liquid  caus- 
tics, in  proportion  as  there  is  more  or  less  difficulty  in  bringing 
them  in  dii'ect  contact  with  the  necrotic  points. 

The  thu-d  method  of  treatment  is  that  of  the  removal  of  the 
cartilage.  This  operation,  first  recommended  by  Lafosse,  Sr.,  in 
1754,  was  often  performed  by  his  sou,  and  may  be  considered  one 
of  the  most  valuable  results  of  the  application  of  anatomical 
knowledge  to  the  practice  of  veterinary  surgery.  This  operation 
was  also  performed  by  Bourgelat  and  his  students,  by  Girard, 
Hurtrel,  D'Arboval,  and  was  principally  studied  and  described  by 
Renault.  In  Germany,  notwithstanding  the  writings  of  Langen- 
bacher,  Dieterichs  and  Hertwig,  it  did  not  meet  with  approval, 
and  EngHsh  veterinarians  seldom,  if  ever,  resorted  to  it.  At  pres- 
ent, even  in  France,  it  is  seldom  performed,  except  in  case  of  fail- 
ure by  the  caustic  injection  treatment,  and  this  is  often  the  case 
where  the  disease  is  situated  in  the  anterior  part  of  the  fibro- 
cartilage,  where  the  cartilaginous  tissue  predominates,  or  where 
the  vitality  is  diminished,  and  above  all,  where  ossification  has 
taken  place.  It  is  an  operation  of  the  greatest  delicacy,  and  ac- 
companied with  great  risks  on  account  of  the  proximity  of  the 
joint  of  the  foot,  and  it  requires  an  experienced  operator  and 
thorough  practitioner  to  justify  a  hope  of  successful  results.  It 
consists  in  the  excision,  by  layers,  of  the  diseased  cartilage,  and 


72G  OPERATIONS    ON    THE    FOOT. 

in  avoiding  injury  to  the  coronary  band,  and  to  the  podophyllous 
tissue,  which  are  essential  elements  of  the  organization  of  the 
foot.  It  is  also  essential  to  avoid  injury  of  the  lateral  ligament 
of  the  foot  joint,  which  is  close  to  the  cartilage,  and  above  all,  of 
the  synovial  capsule  of  the  joint,  which  is  directly  covered  by  the 
cartilage.  The  partial  or  entire  extirpation  of  the  cartilage  can 
be  performed.  In  the  first  case,  only  a  portion  of  the  necrosed 
fibro-cartilage  is  removed.  Vatel,  Sanstas,  Renault,  Bell  and  La- 
fosse  have  reported  many  cases  of  recovery  by  this  mode  of  oper- 
ation, but  it  is  not  Ukely  to  be  thoroughly  successful,  unless  in 
circumstances  as  favorable  as  .those  accomj)anying  the  treatment 
by  liquid  caustics.  It  is  generally  much  better  when  the  operation 
is  decided  uj^on  to  perform  it  by  excising  the  entire  structure,  and 
removing  all  the  carious  elements.  The  partial  removal  is  to-day 
entirely  abandoned,  and  entire  extirpation  accej^ted  as  the  true 
and  only  oj^erative  procedure.  The  best  method  of  performing 
it  is  that  recommended  by  Renault  and  adopted  in  our  colleges. 
We  shall  make  it  the  subject  of  description  with  all  necessary 
details,  and  with  various  modifications  as  performed  by  other 
practitioners ;  we  shall  also  offer  some  observations  upon  various 
other  modes  of  performing  the  operation  in  question. 

The  ojieration  includes  two  principal  steps  :  first  the  removal 
of  the  part,  or  the  whole  of  the  wall  corresponding  to  the  diseased 
cartilage ;  and  second,  the  extirpation  of  the  cartilage  itself.  The 
opinions  of  surgeons  vary  as  to  the  amount  of  hoof  which  should 
be  removed,  and  the  extent  of  horny  tissue  to  be  taken  off.  In 
respect  to  the  length  of  the  superior  border  of  the  portion  requir- 
ing removal,  it  is  generally  agreed  that  it  must  extend  from  the 
anterior  extremity  of  the  cartilage  backward,  that  is,  the  two  pos- 
terior thirds  of  the  space  reaching  from  the  toe  to  the  heels,  or 
one-third  of  the  circumference  at  the  coronary  band.  But  opinion 
continues  divided  as  to  the  lower  border  (Fig.  527).  Lafosse,  Sr., 
left  it  longer  than  the  superior,  and  made  the  direction  of  the 
division  of  the  groove  corresjjond  to  that  of  the  fibres  of  the  hoof. 
Lafosse,  Jr.,  accepting  the  idea  of  Solleysel  and  of  Dieterichs,  did 
not  reach  the  sole  with  its  groove,  and  removed  only  a  portion  of 
hoof  parallel  to  the  coronary  band.  Renault  prefers  crossing  the 
fibres  of  the  hoof  with  the  groove,  and  brings  the  lower  end  of  it 
to  one-half  the  dimensions  of  the  upper  border,  its  groove  running 
backward.     Rey  considers  this  to  be  running  too  far  back  and 


727 


Fig.  537.— Direction  the  Groove  should  take  to  remove  the  Quarter  In  the  Operation 
for  Cartilaginous  Quitter.  A  £.— According  to  Lafosse.  A  C— According  to  Eey.  A  D. 
—According  to  Renault.    A  ^.—According  to  Lafosse  and  Dietericths. 

too  near  the  heel,  and  recommends  the  groove  to  be  so  made  that 
the  lower  border  will  have  the  same  length  as  the  upper,  and  for 
that  reason  advises  that  it  be  as  nearly  parallel  as  j)ossible  with 
the  line  of  the  heels.  Lafosse,  Sr.,  removes  too  large  a  portion  of 
the  hoof.  Lafosse,  Jr.,  leaves  a  portion  of  hoof  which  not  only  is 
useless,  but  which  interferes  with  certain  steps  of  the  operation, 
when  with  the  double  sage  knife,  the  skin  is  separated  from  the 
external  surface  of  the  cartilage,  and  also,  when  this  is  removed ; 
and  again,  there  is  a  separation  between  the  severed  portions  of 
the  quarters  much  greater  than  occurs  in  the  process  of  Renault, 
which,  like  that  of  Rey,  exposes  the  entire  cartilage,  and  greatly 
facilitates  the  operation. 

It  is  to  be  understood  that  the  foot  has  been  prepared ;  that 
the  hair  has  been  clipped  over  the  skin  covering  the  cartilage; 
that  the  sole  has  been  pared  thin,  down  to  the  blood,  as  well  as 
the  bar  corresponding  to  the  diseased  cartilage,  so  that  the  quarter 
has  been  allowed  to  project  below  the  sole,  to  facilitate  its  aver- 
sion. The  foot  has  been,  moreover,  well  prepared  by  two  or  three 
days  of  poulticing,  to  render  the  hoof  easier  to  be  cut  by  the  in- 
strument, and  the  operation  easier  to  j)erform,  and  therefore 
shorter  in  its  various  steps,  beside  placing  the  patient  in  the  best 
condition  for  the  endurance  of  so  serious  an  oj)eration. 

After  casting  the  animal  upon  a  good  bed,  and  fixing  the  feet, 
placing  a  temporary  hemostasis,  by  the  use  of  a  strong  cord,  simi- 
lar to  a  tourniquet,  around  the  coronet,  a  groove  is  made,  using 
various-sized  drawing-knives,  running  from  the  anterior  angle  of 
the  lower  border  of  the  cartilage  downward  to  the  sole,  following 


728  OPERATIONS    ON    THE    FOOT. 

tlie  direction  recommended  by  Lafosse,  Sr.,  Eey,  or  Renault.  This 
groove,  made  first  with  the  widest,  and  finished  with  the  narrow- 
est of  the  drawing  knives,  must  not  touch  the  podophyllous  tissue, 
and  still  must  run  thi'ough  the  entu'e  thickness  of  the  wall,  with- 
out producing  hemorrhage.  In  this  step  of  the  operation,  as 
Girard  correctly  observes,  short  cuts  of  the  knife  are  always  bet- 
ter and  quicker  than  those  made  by  scraping  or  dragging  with 
the  instrument.  It  is  also  important  to  come  down  to  the  soft 
tissue  at  the  coronary  band  first,  and  successively  downward  to 
the  inferior  border  of  the  waU,  as  otherwise,  as  the  instrument  is 
moved  from  above  downward,  with  a  certain  amount  of  force,  it 
might  slip  and  cause  a  serious  division  or  laceration  of  the  podo- 
phyllous tissue.  The  separation  is  then  made  of  the  wall  from 
the  sole  by  another  groove,  extending  from  the  end  of  the  groove 
already  made,  on  the  quarter,  back  to  the  heels.  This  is  done 
without  difficulty,  with  a  smaU  drawing-knife,  when  the  foot  has 
been  properly  prepared.  There  is,  however,  one  point  which 
usually  offers  more  or  less  resistance  when  the  quarter  is  removed. 
It  is  that  where  the  wall  is  continued  to  the  bars.  This  resistance 
is  sometimes  so  considerable  that  if  much  traction  is  made,  the 
wall  will  break  more  or  less  in  front  of  the  heels,  where  it  is  com- 
paratively thin,  and  it  may  consequently  become  necessary  to  re. 
move,  by  itself,  the  portion  which  has  remained  attached.  This 
little  accident,  however,  can  be  avoided  by  ascertauiing  certainly 
before  the  extraction  of  the  wall  is  effected,  that  the  continuity  of 
the  wall  and  bars  has  been  cut  off.  This  being  the  case,  the  com- 
plete separation  of  the  wall  from  the  sole  is  made  by  running  the 
sharp  edges  of  the  double  sage  knife  through  the  structure  of  the 
living  tissue  underneath.  The  resection  of  the  quarter  can  then 
be  proceeded  with. 

For  this  purpose,  a  properly  constructed  lever  is  carefully  in- 
troduced into  the  groove  before  mentioned,  at  the  wall  and  sole  of 
the  foot.  The  inferior  and  anteiior  angle  of  the  hoof  at  this  point 
being  then  carefully  raised,  an  assistant  grasps  it  with  the  nippers, 
turns  it  back  and  tears  it  slowly,  while  the  surgeon,  with  such  a 
motion  of  the  lever  as  may  be  necessary,  assists  in  the  tearing  off 
of  the  portion  of  the  quarter  requiring  removal.  If  adhesions 
remain,  interfering  with  this  manij)ulation,  they  are  removed  by 
cutting  with  a  sharp  instrument.  As  this  separation  of  the  wall 
reaches  about  to  the  coronary  band,  the  separation  is  very  easy, 


DISEASES.  729 

and  no  fear  of  lacerating  the  soft  structures  need  be  entertained. 
Care  is  necessary  at  this  step,  however,  to  avoid  injuring  the  cor- 
onai-y  band,  and  the  podophyllous  tissue ;  to  prevent  which  it  will 
be  prudent  on  the  part  of  the  assistant  to  press  upon  the  band  as 
the  separation  takes  place. 

This  being  accomplished,  the  edges  of  the  wound  are  carefully 
examined;  any  projections  remaining  are  removed,  and  the  blood 
is  sponged  off.  The  double  sage  knife  is  then  carefully  plunged, 
with  the  convexity  turned  upward  (that  is,  toward  the  skin),  be- 
tween the  external  surface  of  the  cartilage  and  the  internal  face  of 
the  skin,  below  the  border  of  the  coronary  band,  and  then  cai^ried 
forward  and  backward,  or  as  required,  until  the  separation  of  the 
skin  and  the  cartilage  is  completed  and  the  external  surface  of  the 
cartilage  is  exposed.  In  moving  the  instrument  backward,  it  is 
necessary  to  be  very  cautious,  especially  while  carrying  the  sharp 
edges  downward  and  inward,  in  order  to  avoid  injury  to  the  cor- 
onary band  and  the  skin,  of  which,  however,  there  can  be  but  little 
danger,  when  the  knife  is  carefully  held  and  properly  directed. 
The  succeeding  step  is  to  separate  the  skin  from  the  cartilage ;  it 
is  to  be  carefully  raised  and  separated  from  its  attachments  under- 
neath, which  is  sometimes  a  process  quite  difficult  to  accomplish, 
as  the  skin  has  always  become  more  or  less  tumefied,  and  there- 
fore has  lost  much  of  its  natural  flexibility  and  suppleness.  Some 
operators,  in  order  to  avoid  these  difficulties,  and  overlooking  the 
functions  of  the  coronary  band,  cut  it,  and  remove  it,  with  those 
portions  of  the  skin  which  cover  the  cartilage.  Others,  more  con- 
servative (Herting,  for  example)  cut  it  only  through  the  middle, 
until  they  reach  the  superior  border  of  the  cartilage,  and  then, 
raising  the  two  flaps  of  the  skin,  accomplish  the  same  result  with 
less  cutting. 

The  destruction  of  the  principal  organ  of  the  secretions  of  the 
hoof  having  been  involved  in  the  first  method,  and  having  now 
taken  place,  it  can  never  be  restored  to  a  healthy  condition,  and 
the  animal  continues  to  be  exposed  to  the  frequently  serious  com- 
plications of  "false  quarter."  By  the  second  method,  the  produc- 
tion of  a  new  wall  is  nearly  always  accompanied  with  the  forma- 
tion of  a  "quarter  crack."  The  recovery  is  slow  in  either  case, 
and  more  or  less  deformity  is  likely  to  follow.  It  is,  then,  the 
better  and  wiser  plan  to  separate  the  skin  from  below,  and  to 
avoid  the  division  of  the  coronary  bands  or  of  the  teguments. 


730  OPERATIONS    ON    THE    FOOT. 

The  next  step  is  the  removal  of  the  cartilage  altogether.  This 
is  done  with  the  single  sage  knife,  held  firmly  in  the  hand,  either 
the  left  or  the  right,  always,  however,  that  corresponding  to  the 
side  of  the  heel  to  be  operated  upon.  Taking  a  point  of  rest  with 
the  flat  of  the  thumb  upon  the  plantar  surface  of  the  foot,  the  in- 
strument is  pushed  between  the  skin  and  the  cartilage,  and  the 
sharp  edge  turned  backward,  with  a  firm  rotary  motion,  down- 
ward and  forward.  The  detached  portion  of  cartilage  is  then 
seized  with  a  pair  of  bull-dog  forcej)s,  and  brought  outward,  and 
the  sage  knife  is  brought  forward,  downward  and  outward,  from 
under  the  cartilage.  It  is  a  good  plan,  in  order  to  make  more 
room  for  working,  to  raise  the  skin  and  coronary  band  with  a 
blunt  tenaculum.  The  operation  should  always  be  commenced 
at  the  posterior  part,  in  order  to  avoid  the  articular  synovial  cap- 
sule, which  might  be  opened  if  the  removal  of  the  cartilage  was 
begun  forward.  As  the  operator  reaches  the  anterior  part  of  the 
cartilage,  which  is  situated  almost  over  this  capsule,  it  is  prudent 
to  hold  the  foot  in  excessive  extension,  and  thus  avoid  injury  to 
the  capsule.  This  is  an  important  point  to  consider  in  the  oper- 
ation. The  sharp  instrument  being  carefully  handled,  every  por- 
tion of  the  cartilage  is  taken  ofi",  either  at  once,  or  better  by  layers 
successively,  until  the  whole  is  removed.  It  is  thus  accomplished 
in  three  or  four  pieces.  In  some  instances  the  anterior  portion  is 
cut  off  by  a  longitudinal  incision,  made  with  a  straight  bistoury, 
following  the  direction  of  the  posterior  face  of  the  coronet,  the 
object,  in  this  case,  being  simply  to  render  the  operation  easier. 
The  cartilage  is  thus  removed,  great  care  being  taken  to  avoid 
opening  the  capsular  articular  bursse.  It  is  essentially  necessary 
to  remove  the  whole  of  the  diseased  tissues,  in  order  to  bring  the 
parts  into  the  condition  of  a  simple  wound.  Still,  there  need  be 
no  alarm  if  some  small  portions  remain,  more  fibrous  than  cartilag- 
inous, which,  deep  as  they  are,  may  protect  the  synovial  capsules 
or  the  ligament ;  and  moreover,  they  often  slough  off  by  them- 
selves, with  the  abundant  suppuration  which  follows. 

To  operate  with  the  greater  facility,  it  is  well  to  have  two  forms 
of  sage  knife,  one  right  and  one  left-handed,  and  some  of  extra 
strength,  with  which  to  remove  the  larger  particles  of  cartilage, 
the  others  being  small,  thin  and  light,  being  adapted  to  the  more 
careful  dissection  necessary  toward  the  lateral  ligament,  and 
about  the  synovial  bm-sse  of  the  joint. 


DISEASES.  731 

Toward  the  end  of  the  operation,  the  surgeon  will,  with  the 
finger,  carefully  explore  the  condition  of  the  parts,  to  insure  him- 
self that  the  cartilage  is  entirely  removed ;  that  the  articular  syn- 
ovial sac  has  been  preserved  intact;  that  the  ligament  of  the  joint 
remains  -periect,  and  that  the  parts  are  well  washed,  and  ready  for 
the  dressings.  Although  in  the  absence  of  possible  complications, 
the  operation  is  now  finished,  it  may  yet  be  followed  by  some 
serious  sequelae,  which  we  will  next  consider. 

The  operation  may  become  complicated  by  a  variety  of  atten- 
dant and  accessory  cii^cumstances.  Among  these  are,  the  opening 
of  the  articular  capsules;  the  wounding  of  the  anterior  lateral 
ligament  of  the  articulation ;  the  ossification  of  the  fibro-cartilage ; 
caries  of  the  os  pedis ;  and  the  alteration  of  the  coronary  band 
and  of  the  reticular  tissue. 

The  opening  of  the  articular  capsule,  either  during  the  oper- 
ation, or  by  ulcerative  process,  is  not  so  serious  an  accident  as  it 
was  originally  thought  to  be.  Still,  however,  it  requires  some  at- 
tention. It  only  becomes  dangerous  when  the  ulceration  is  ac- 
companied by  serious  disorganization,  and  especially  when  it  is 
associated  with  purulent  arthritis.  (Renault,  Hurtrel,  D'Arboval, 
Bernard).  It  is  treated  by  simple  pressure,  camphorated  jiaste,  a 
little  corrosive  sublimate  mixed  with  starch,  or  better,  with 
Egyptiacum  ointment. 

llie  toound  of  the  ligaments  has  also  been  considered  a  very 
serious  accident,  which,  according  to  Girard,  cripples  an  animal 
permanently.  But  Lafosse  thinks  this  an  exaggerated  notion,  and 
claims  to  have  witnessed  the  radical  recovery  of  animals  after  the 
necrosis  and  sloughing  of  the  ligament. 

If  ossification  of  the  cartilage  is  discovered  during  the  opera- 
tion, the  removal  of  all  the  unossified  portion  is  first  jDroceeded 
with,  in  order  to  prevent  a  recurrence  of  the  disease.  The  extir- 
pation of  the  osteo-cartilaginous  portion  is  then  efi^ected,  either 
with  a  small  drawing-knife,  or  the  gouge,  or  the  bone  forceps. 
The  removal  is  made  as  far  as  the  ossification  is  found  to  be  com- 
plete, the  operator  making  sure  that  every  portion  of  cartilage  is 
thoroughly  destroyed.  If  the  ossification  is  but  partial  or  irregu- 
lar, the  surgeon  must  be  guided  by  the  condition  of  the  parts. 
When  the  entire  cartilage  has  undergone  ossification,  its  suscepti- 
bility to  caries  has  ceased. 

When  caries  of  the  os  pedis  exists,  the  part  must  be  destroyed 


732  OPERATIONS   ON    THE    FOOT. 

with  the  sage  knife,  the  gouge,  or  the  chisel,  according  to  the 
existing  conditions.  But  in  this  case,  portions  of  the  reticular 
structure  require  removal,  of  which,  however,  as  little  as  possible 
should  be  destroyed. 

It  may  happen  that  the  portion  of  the  coronary  hand  covering 
the  cartilage  may  be  destroyed,  either  wholly  or  in  part,  either  as 
an  effect  of  the  disease,  or  by  accident  during  the  ojoeration.  In 
the  first  case,  if  the  entire  band  has  been  destroyed,  there  is  noth- 
ing to  be  done.  But  in  the  other  case,  if  any  portions  of  it  re- 
main, care  must  be  taken  to  insure  their  preservation,  as  they 
may  supply  the  necessary  elements  for  a  new,  healthy  secretion  of 
hoof,  and  the  quarter  may  grow  again,  more  soUd  and  less  de- 
formed. If  the  wound  of  the  coronary  band  consists  merely  in  a 
simple  division  of  limited  extent,  the  wisest  course  will  be  to  at- 
tempt to  obtain  union  by  immediate  adhesion,  or  first  intention, 
by  bringing  the  edges  of  the  incision  together  and  maintaining 
the  contact  by  careful  dressing.  "When  the  alteration  of  the  re- 
ticidar  tissue  alone,  is  present,  it  is  very  essential  to  avoid  the  ex- 
cision of  the  injured  laminae.  It  is,  in  fact,  the  better  coui'se  to 
avoid  wholly  the  use  of  sharp  instruments,  and  to  leave  to  the 
natural  process  of  suppuration  the  removal  of  the  disorganized 
jDarts.  Renault  having  observed  how  their  removal  interfered 
with  the  reparative  process,  has  often  left  them  undisturbed,  even 
when  their  dark  color  and  softened  condition  indicated  the  small- 
ness  of  their  chance  of  conservation.  The  success  of  the  oj^era- 
tion  after  a  first  dressing,  has  shown  the  wisdom  of  the  plan  of 
non-interference ;  they  were  found  covered  with  a  new  layer  of 
yellowish  hoof;  and  D'Arboval  has  on  several  occasions  observed 
the  same  result. 

The  dressing  must  be  methodically  and  carefully  applied. 
Done  well,  a  dressing  greatly  assists  in  the  recovery,  while  many, 
when  badly  performed,  have  been  the  cause  of  serious  comi^lica- 
tions,  which  have  greatly  hindered  the  repau-ing  process,  and  of- 
ten, indeed,  rendered  a  disease  inciu'able,  which  need  not  have 
been  beyond  remedy.  In  the  application  of  the  dressing",  two 
points  are  important  to  consider :  first,  we  must  dress  the  subcu- 
taneous wound,  resulting  from  the  separation  of  the  skin  and  the 
extraction  of  the  fibro-cartilage ;  the  other,  that  of  the  sub-horny 
wound,  produced  by  the  removal  of  the  portion  of  the  quarter. 
Both  are  important,  but  the  second  requu'es  the  greater  care,  and 


733 


is  more  difficult  and  more  important  than  the  former ;  any  excess 
in  the  sanguineous  circulation  must  be  prevented,  and  excessive 
granulations  must  be  kept  under  control.  The  dressing,  then, 
must  be  somewhat  compressive,  without  being  excessively  rigid, 
in  order  to  ob^date  possible  danger  of  excessive  inflammation ;  not 
too  loose  or  so  soft  as  to  allow  hemori-hage,  or  the  undue  pro- 
liferation of  granulations.  It  must  be  both  supple  and  firm,  and 
of  an  even  and  uniform  px'essiu'e.  The  proper  material  is  balls  of 
oakum  for  the  subcutaneous  wound,  and  pads  of  the  same  mate- 
rial for  the  sub-horny,  the  first  being  moistened  with  alcohol, 
while  the  others  are  made  dry. 

It  is  in  question  whether  we  should  aim  to  obtain  immediate 
adhesive  union  of  the  wound  resulting  from  the  removal  of  the 
cartilage,  or  in  other  words,  whether  it  is  good  treatment  to  in- 
troduce some  material  of  dressing  between  the  skin  and  the  bot- 
tom of  the  wound.  Here  opinions  vary.  Our  belief  is,  that  this 
union  is  by  no  means  easy  to  secure ;  and  that  the  removal  of  the 
cartilage,  more  or  less  altered,  prevents  it  at  various  points.  Still, 
we  must  not  raise  the  skin  too  much,  and  choosing  a  middle  course 
between,  only  a  small,  soft  ball  of  oakum  is  now  placed  in  the 
deepest  part  of  the  wound,  or  a  thin  pad  is  placed  between  the 
two  parts,  sufficient  to  represent  about  the  natural  form  of  the 
part,  being  enough,  however,  to 
prevent  the  immediate  reunion 
from  taking  place. 

A  Hght,  thin  shoe  having  been 
prepared  (Figure  528),  adapted 
to  assist  the  application  of  the 
dressing  and  its  holding  prop- 
erly, it  is  j)ut  on  with  one  of  its 
branches  cut  off  short  on  the 
side  where  the  operation  has  been 
performed,  while  the  other  branch 
projects  backward  beyond  the 
heel,  to  support  the  roUers  of  the 
bandage  of  the  dressing.  Des- 
plas  had  thought  to  turn  up  that 
long  branch  of  the  shoe  (Fig.  529) 

in  the  shape  of  a  hook  to  assist  in     .    ^'''-  52^--Truncated  Shoe  for  Dressing 

holding  the  dressings.     This  is    plicated  corn. 


734  OPERATIONS    ON    THE    FOOT. 


Fig.  529.— Desplas'  Shoe  for  Dressing  after  Operation  of  Cartilaginous  Quittor  and 
Complicated  Corns. 

useless.  Some  veterinarians  leave  the  animal  unshod,  but  the 
bandage  is  more  likely  to  slij)  off.  The  shoe  must  be  put  on  while 
the  animal  is  down,  and  before  the  application  of  the  dressing. 
"With  some  practitioners,  that  is  the  moment  for  the  removal  of 
the  tourniquet  or  cord,  which  had  been  appHed  at  the  beginning 
of  the  operation  in  order  to  prevent  the  bleeding.  This  is  an  un- 
necessary precaution,  and  only  renders  the  application  of  the 
dressing  more  difl&cult.  First,  balls  of  oakum  are  placed  over  the 
coronary  band,  then,  upon  the  points  of  union  of  the  preserved 
wall  and  of  the  podophyllous  tissue,  and  then  all  over  the  wound. 
We  must  endeavor,  as  Renault  says,  to  give  the  di'essing  a  cylin- 
drical form,  or  rather,  according  to  Rey,  hemispherical,  after  which 
the  whole  is  covered  with  pads  and  rollers.  These  must  be  put 
on  in  abundance,  the  rollers  passing  over  the  branch  of  the  shoe 
on  the  sound  side,  and  running  successively  from  above  down- 
ward, and  generally  from  before  backward  (Figs.  530,  531,  532, 
533).  Flat  feet  require  sjDecial  care  in  dressing,  and  the  fore  feet 
are  generally  more  difficult  to  dress  than  the  hinder.  "When  all  is 
finished,  the  animal  has  to  be  watched  for  several  days.  Ordi- 
narily, after  the  operation,  there  is  abundant  hemorrhage,  occur- 
ring within  some  fifteen  minutes,  and  oozing  through  the  dress- 
ings. This  requires  no  special  attention,  and  generally  ceases 
spontaneously,  or  by  the  pressure  of  the  dressing,  or  by  the  use 
of  the  cold  bath.  If  the  dressing  seems  to  be  too  tight,  and  the 
animal  shows  signs  of  acute  pain,  with  strong  reactive  fever,  it  is 
not  therefore  necessary  to  remove  the  dressing,  but  may  be  suffi- 
cient simply  to  loosen  the  bandage.  The  animal  should  be  j^laced 
in  a  wide  stall,  or  box,  if  possible,  where  he  may  move  freely,  and 


r35 


VARIOUS  STEPS  IN  THE  APPLICATION  OF  THE  DRESSING  AFTER  OPERA- 
TION  FOR  CARTILAGINOUS  QUITTOR. 


PKt   53^  —id  btPl) 


FiCt  5^3     Dressing  (  ompleted. 


lie  down  easily ;  and  lie  must  be  prevented  from  tearing  off  the 
dressing  by  the  application  of  a  neck  cradle.  A  low  diet  is  neces- 
sary for  several  days,  in  some  instances  mashes  being  the  only 
food  allowed.  Still,  a  good  appetite  and  lively  condition  are  always 
good  signs. 

The  interval  of  time  which  should  be  allowed  to  elapse  be- 
tween the  operation  and  the  removal  of  the  first  dressing,  should 
be  judged  by  the  amount  of  pain  which  the  animal  seems  to  suf- 
fer ;  by  the  temperature  of  the  atmosj^here ;  and  by  the  amount  of 
liquid  discharge  found  oozing  from  the  wound  and  moistening 
the  dressing  which  covers  and  protects  it.  Generally,  the  dress- 
ings should  be  disturbed  as  late  and  as  seldom  as  possible.  Cir- 
cumstances will  sometimes  occur,  however,  which  necessitate  their 
removal  earlier,  as  for  example,  the  extreme  heat  of  the  weather; 


736  OPERATIONS    ON    THE    FOOT. 

the  extremely  offensive  odor  proceeding  from  the  diseased  parts; 
and  a  sudden  and  evident  increase  of  pain  in  the  wound,  without 
any  known  cause.  Under  these  circumstances,  which,  however, 
are  of  rather  infrequent  occurrence,  it  is  sometimes  necessary  to 
remove  the  dressing  as  early  as  the  third  day,  although  at  this 
time,  as  suppuration  is  not  yet  well  established,  the  operation  is 
quite  painful,  and  may  be  accompanied  by  free  hemorrhage.  But 
if  the  weather  is  not  excessive;  or  the  di'essing  remains  di'y  on 
the  outside,  and  matters  seem  to  be  generally  in  good  condition, 
the  better  course  is  to  wait  from  eight  to  ten  days,  before  the 
dressing  is  renewed.  Indeed,  numerous  cases  are  on  record  when 
a  still  longer  period  has  been  allowed  to  elapse,  and  the  re-dress- 
ing has  been  deferred  to  the  extent  of  three  weeks,  or  longer.  In 
any  event,  great  caution  must  be  exercised  in  the  removal  of  the 
dressings,  and  the  surgeon  should  be  careful  to  have  all  his  ap- 
pliances ready  in  advance,  in  order  that  the  wound  may  be  ex- 
posed to  the  air  for  the  shortest  possible  space  of  time.  WTien 
exposed,  the  wound  should  be  of  a  red  color,  with  commencing 
granulations,  and  a  temporary  hoof,  soft  and  whitish  in  appear- 
ance, should  be  visible  on  the  podophyllous  tissue.  A  di-essing  is 
then  applied  of  tincture  of  aloes,  or  a  weak  solution  of  iodine. 
At  a  later  period  the  dressings  are  changed  at  intervals  of  about 
eight  days,  and  an  apjihcation  is  made  of  pulverized  sulphate  of 
copper,  in  order  to  facilitate  the  drying  and  hardening  of  the  soft 
hoof.  Baths  of  sulphate  of  iron,  with  a  small  portion  of  sulphate 
of  copper  are  of  service  in  promoting  and  hastening  the  cicatriza- 
tion. 

About  the  thirtieth  or  fortieth  day  after  the  extirpation  of  the 
cartilage,  the  animal  may  be  put  to  Hght  work.  But  three  or  four 
months,  if  not  a  longer  period,  must  elapse,  before  it  will  be  safe 
to  task  him  with  heavy  labor.  Toward  the  end  of  the  assigned 
term  he  should  be  fitted  with  a  bar  shoe,  shortened  on  the  side 
where  the  qviittor  has  existed.  If  the  dressing  is  skillfully  appUed 
and  proper  care  is  exercised,  the  diseased  foot  may  be  sufficiently 
protected,  and  the  animal  made  to  resume  his  work  with  safety. 

In  time,  the  jDortion  of  hoof  secreted  by  the  coronary  band 
unites  with  that  of  the  podophyllous  tissue,  and  after  a  few 
months,  no  remains  of  the  operation  are  visible.  But  if  the  cor- 
onary band  has  ulcerated;  if  the  skin  has  been  divided;  if  by 
contact  of  the  firing  iron,  or  application  of  caustics,  it  has  been 


DISEASES.  737 

■destroyed;  the  quarter  then  presents  irregularities,  and  some- 
times divisions,  which  may  be  of  long  continuance,  and  give  rise  to 
a  lameness  which  may,  perhaps,  become  permanent.  This  danger 
indicates  the  necessity  of  exercising  the  utmost  skill  and  caution 
in  operating,  in  order  to  avoid  possible  injuries  to  the  coronary 
band. 

Several  modifications  of  the  ordinary  mode  of  operation  have 
been  proposed.  Some  have  had  for  their  principal  object,  the 
prevention  of  the  extraction  of  the  hoof,  with  a  view  of  thus  re- 
turning the  animals  to  their  work  at  the  earhest  period  practic- 
able. It  is  thus  that  Hazard,  Jr.,  proposed  to  make  a  crucial 
incision  upon  the  skin  covering  the  fibro-cartilage ;  the  four  flaps 
being  so  dissected  as  to  expose  it,  and  then  removing  it  with  the 
sage  knife.  In  this  process,  the  extirpation  of  the  entire  cartilage 
becomes  extremely  difficult  without  inflicting  injury  upon  the  lat- 
eral hgaments  and  the  synovial  capsules. 

Pagnier  has  proposed  to  merely  thin  down  the  quarter,  to 
make  an  incision  in  the  skin  along  the  superior  border  of  the  car- 
tilage, and  through  this  to  remove  the  organ.  But  in  this  opera- 
tion, however  thin  the  hoof  may  be,  it  always  interferes  with  the 
entire  extirpation  of  the  cartilage. 

Bernard,  following  the  idea  of  Lafosse  junior,  who  only  re- 
moved the  superior  border  of  the  wall,  proposed  a  mode  of  pro- 
ceeding which  is  principally  useful  in  cases  of  separation  of  the 
hoof.  Instead  of  removing  the  band  of  hoof  parallel  with  the 
coronary  bourrelet,  Bernard  pared  it  down  with  the  drawing- 
knife,  the  sage-knife,  or  the  rasp,  in  order  to  make  it  as  thin  as 
possible,  while  avoiding  the  injury  to  the  sensitive  laminae.  This 
done,  an  incision  is  made  along  the  coronary  band,  below  it,  de- 
stroying its  union  with  the  laminse.  At  this  step  of  the  operation, 
the  indications  are  the  same  as  in  the  ordinary  modus  operandi, 
except  that  the  coronary  band  being  covered  with  a  certain  thick- 
ness of  hoof,  is  less  flexible.  This,  however,  is  easily  removed,  as 
soon  as  it  becomes  softened.  The  remaining  steps  of  the  opera- 
tion are  the  same  as  in  the  ordinary,  old  way.  That  is  to  sa}',  the 
posterior  part  of  the  cartilage  being  well  defined,  the  sage-knife 
is  used  in  the  same  manner.  In  this  method,  however,  as  the 
sage-knife  works  more  flat-wise,  there  is  less  danger  of  wounding 
the  ligaments  or  the  synovial  capsules.  If  any  part  of  the  car- 
tilage remains  near  these  organs,  some  care  must  be  used  in 


7db  OPERATIONS    ON    THE    FOOT. 

removing  it,  and  it  must  be  done  by  degrees,  and  in  very  small 
portions. 

The  advantages  of  this  process  are :  1st,  the  avoidance  of  ex- 
tensive wounds,  and  of  the  extreme  pain  produced  by  the  extirpa  • 
tion  of  the  quarter.  2d,  to  keep  the  foot  shod,  and  to  allow  the 
animal  to  resume  his  work  as  soon  as  the  first  pain  has  subsided, 
which  may  occur  at  quite  a  considerable  interval  in  advance  of 
the  perfect  cicatrization  of  the  wound.  3d,  to  avoid  long  and  fre- 
quently-repeated dressings. 

In  this  method,  however,  the  quarter  left  intact  sometimes  in- 
terferes with  the  operation,  and  the  excision  of  the  cartilage  is 
more  difficult,  being  only  practicable,  indeed,  in  cases  where  there 
is  a  separation  of  the  wall. 

Maillet  has  modified  the  method  of  Bernard,  so  that,  instead 
of  thinning  down  the  band  of  hoof,  he  only  appHes  the  rasp  upon 
the  quarter,  and  thins  down  with  it  all  that  portion  which  is  ex- 
tirpated in  the  process  of  Kenault,  and  availing  himself  also,  of 
the  drawing  and  sage-knives.  The  remaining  details  of  the  oper- 
ation are  like  those  of  the  ordinary  processes.  An  objection  to 
this  mode  is  that  it  can  be  put  in  practice  only  in  cases  where 
there  is  already  a  separation  of  the  wall.  It  is  objectionable  from 
its  tendency  to  weaken  the  foot  too  much,  by  interfering  with  the 
firm  and  solid  adjustment  of  the  shoe,  as  well  as  retarding  its 
application  to  the  hoof. 


CHAPTEK  XIV. 

OPERATIONS  UPON  THE  EYE  AND  EAR. 

ON  THE  EYE. 

Ophthalmology,  though  it  has  made  appreciable  progress  in  vet- 
erinary practice  within  a  few  years,  has  not  yet  reached  a  position 
corresponding  with  that  which  it  occupies  in  human  surgery,  and 
probably  will  not  for  years  to  come,  if  ever.  The  difference  in 
value  and  importance  between  the  functions  of  the  organ  of  sight 
in  the  man  and  in  the  horse  is  too  measureless  to  induce  or  re- 
quire an  equal  amoimt  of  interest  and  study  in  the  optical  path- 
ology of  the  two  animals,  the  haman  and  the  eqviine.  It  is  in- 
deed, a  fact  that  many  of  the  forms  of  disease  which  affect  the 
eye  of  the  horse  have  not  yet  been  recognized  and  investigated  by 
students  of  veterinary  medicine. 

For  these  reasons  the  contents  of  the  present  chapter  will  be 
limited  to  those  affections  in  which,  strictly  speaking,  special  sur- 
gical interference  has  been  so  imperatively  needed  as  to  compel 
the  attention  of  scientific  veterinarians,  by  considerations  of  both 
duty  and  interest. 

"We  shaU  consider  the  subject  under  two  principal  divisions, 
or  heads,  viz.,  operations,  performed  on  the  accessory,  and  those 
pertaining  to  the  essential  organs  of  the  ocular  apparatus. 

1. — Operations  Perfoemed  on  the  Accessory  Ocular  Organs. 

On  the  Eyelids. — These  constitute  the  two  cutaneo  or  mu- 
cous veils,  which  are  situated  in  front  of  the  organ,  and  are  divided 
into  superior  and  inferior,  uniting  at  their  extremities  to  form  the 
angles  or  commissures  of  the  eye.  Besides  these,  there  is  a  pecu- 
liar apparatus  situated  on  the  internal  or  nasal  angle,  known  as  a 
third  eyelid,  or  menbrana  nictitans.  This  is  a  small  cartilage, 
thinned  out  on  its  free  border,  continued  on  its  posterior  portion 
with  the  adipose  cushion  of  the  eye,  and  covering  it  in  front, 
wiping,  as  it  were,  its  corneal  surface,  whenever  the  ocular  globe 


740  OPEEATIONS  UPON  THE  EYE  AND  EAK. 

is  drawn  back  into  the  orbital  cavity.  On  the  internal  commis- 
sure are  found  the  caruncula  lachrynialis,  showing  on  the  upper 
and  lower  lids  the  lachrymal  puncta,  both  of  which  empty  into 
the  lachrymal  sac,  which  is  itself  continuous  with  the  lachrymal 
canal,  and  through  the  lachrymal  duct  empties  at  the  lower  com- 
missure of  the  nostril  by  the  lachrymal  opening. 

Among  the  surgical  diseases  of  the  eyehds  must  be  mentioned 
traumatic  lesions,  pathological  growths,  defective  congenital  con- 
formations, and  specific  diseases  of  their  elements. 

A. — Traumatic  Lesions. 

Bruises  of  the  eyelids  are  specially  common  in  horses  after 
kicks  and  blows  in  that  region,  and  may  also  be  the  result  of  fric- 
tion and  chafing  from  the  harness.  If  the  cause  has  been  severe, 
oedema  of  the  lid  is  the  result,  as  well  as  more  or  less  flow  of 
tears,  and,  possibly,  irritation  of  the  cornea.  These  accidents  are 
generally  of  no  great  severity  so  long  as  the  globe  of  the  eye  re- 
mains intact,  but  if  this  is  injured  serious  complications  ensue. 

The  indications  of  treatment  are  those  of  all  similar  injuries 
of  a  local  character,  consisting  of  cooling  astringents,  with  local 
bleeding,  which  generally  bring  rapid  rehef. 

B. — Solutions  of  Continuity. 

These  are  very  common  with  all  our  animals.  They  are  sel- 
dom simple,  but  are  more  commonly  complicated  with  lacerations 
of  the  tissues,  by  naUs,  hooks,  etc.,  or  even  the  teeth  of  other 
animals.  Clean  wounds  by  sharp  instruments  are  rare,  and  are 
easier  to  treat  than  those  having  torn  and  in-egular  edges.  They 
may  be  superficial,  and  may  involve  the  thickness  of  the  lid  alone, 
but  they  may  also  be  deep  and  complicated  with  wounds  of  the 
globe  of  the  eye  itself.  The  condition  of  the  wound  in  this  re- 
spect is  important  to  know,  and  should  be  ascertained  as  early  as 
possible.  The  raising  of  the  eye  with  the  elevator  palpoebrum 
(Fig.  534)  greatly  faciUtates  this  examination,  and  the  animal  sel- 
dom offers  any  serious  resistance  to  it. 


Fig.  534.— Eyelids  Elevator. 


SOLUTIONS    OF    CONTINUITY.  741 

Simple  lacerations  of  the  lids  commonly  lieal  without  any  treat- 
ment beyond  mere  cleanliness — a  soft  sponge  and  a  little  clean 
water.  But  the  application  of  the  pin  or  twisted  suture,  in  con- 
nection with  antiseptic  measures  will  greatly  promote  cicatrization 
by  the  first  intention.  Care  must  be  taken  to  confine  the  animal's 
head  in  such  a  manner  as  to  prevent  him  from  rubbing  the  wound 
until  cicatrization  is  well  established. 

C. — Defective  Congenital  Conformations. 

Under  this  head  we  shall  consider  the  deviation  of  the  lids, 
either  outwardly  or  inwardly,  from  the  convex  lines  of  the  cornea, 
with  which  they  should  be  parallel.  A  deviation  in  the  growth 
of  the  eyelashes,  or  cihse,  is  another  annoying  irregularity  of  the 
same  region.  The  outward  deviation  of  the  eyelid  is  called  ectro- 
pion;  the  inward,  entropion.  The  deviation  of  the  eyelash  is 
known  as  trichiasis. 

1.  Ectropion. — The  two  principal  causes  of  this  abnormal 
condition  are  an  excess  of  mucous  membrane  or  deficiency  of 
skin.  Again,  the  ectropion  depending  upon  paralysis  of  the  orbic- 
ularis palpoebrum,  is  of  a  different  nature.  Ectropion  occurs  more 
frequently  in  the  lower  than  in  the  upper  lid  When  dejaending 
on  a  want  of  skin,  it  is  generally  the  result  of  a  wound  or  a  burn, 
or  possibly  of  an  abscess,  and  is  a  cicatricial  ectropion.,  in  which 
the  retraction  of  the  cicatricial  tissue  has  carried  the  lid  with  it. 

Paralytic  ectropion  is  the  result  of  age,  and  is  more  or  less 
peculiar  to  old  animals.  It  may  also  result  from  a  diseased  condi- 
tion of  the  conjunctiva,  or  of  some  of  the  organs  of  the  orbital 
cavity. 

The  treatment  of  a  case  of  this  affection  should  be  modified 
by  the  nature  of  its  cause.  If  it  is  due  to  excess  in  the  mucous 
membrane,  the  redundancy  must  be  reduced.  If  caused  by  want 
of  cutaneous  surface,  the  remedy  must  be  applied  to  that  surface. 
If  a  hyphertrophied,  mucous  membrane  is  the  trouble,  astrin- 
gents, caustics,  and  scarifications  must  be  emjjloyed ;  or  even  the 
removal  of  portions  of  the  conjunctival  mucous  membrane,  with 
the  scissors  or  the  bistoury.  If,  on  the  contraiy,  the  deformity 
results  from  the  condition  of  the  skin,  hUpharoplasty  or  hlepha- 
rortapy  must  be  resorted  to.  The  simplest  manner  of  operating 
consists  in  amputating  a  V-shape  portion  of  the  eyehd  and  uniting 
the  edges  with  stitches. 


742  OPERATIONS  UPON  THE  EYE  AND  EAR. 

2.  Entropion. — This  is  a  malformation  in  which  the  border  of 
the  hd  is  turned  inward.  "SMiile  in  an  ectropion  the  skin  is  in 
excess,  the  reverse  condition  is  discovered  here,  where  it  is  defi- 
cient. It  is  often  the  result  of  ophthalmic  attacks,  and  it  may 
also  follow  a  loss  of  substance  in  the  conjunctiva,  after  ulceration, 
or  the  removal  of  foreign  growths.  According  to  JJeblanc  and 
D'Ai'boval  it  may  follow  some  eruptive  fevers,  or  parasitic  dis- 
eases. In  entropion  there  is  an  increased  flow  of  tears,  abundant 
muco-purulent  secretion,  keratitis,  which  may  become  ulcerative, 
and  loss  of  sight. 

The  treatment  consists  in  the  excision  of  all  the  inverted  por- 
tion of  the  deformed  lid,  which  is  accomplished  by  raising  it  from 
the  globe  with  a  forceps,  and  separating  it  with  a  single  cut  of 
the  curved  scissors,  the  protruding  portion  being  then  amputated. 
The  hemorrhage  is  stopped  with  cooling  lotions. 

Another  mode  of  operating  consists  in  cutting  off  only  a  por- 
tion of  the  skin  of  the  lid,  and  unfolding  it  by  passing  the  finger 
under  the  inverted  border.  Then  a  fold  of  skin  is  amputated  near 
the  free  border  of  the  lid,  and  the  edges  brought  together  by 
twisted  pin  suture. 

3d.  The  deformity  of  trichiasis,  or  abnormal  growth  of  the 
lashes  has  been  observed  by  Leblanc  in  sheep,  but  in  our  domestic 
animals  is  a  rare  disease. 

Amputation  of  a  portion  of  the  skin ;  pulling  out  the  eyelashes, 
followed  by  cauterization,  and  extirpation  of  the  free  border  of 
the  lids,  have  all  been  recommended  against  this  abnormality  of 
cutaneous  secretion. 

D. — Pathological  Growth  and  Caries  of  the  Membrana 

NiCTITANS. 

Acute  inflammation  of  the  third  eyehd,  either  as  a  symptom 
of  ophthalmia,  or  resulting  from  direct  traumatism,  such  as  blows, 
or  the  presence  of  foreign  bodies,  terminating  in  caries  of  the 
constituent  cartilage  of  this  delicate  organ,  or  the  formation  and 
development  of  epitheUoma  of  the  mucous  membrane,  are  condi- 
tions often  seen  in  our  domestic  animals,  principally  in  horses  and 
dogs.  We  have  often  noticed  this  peculiar  affection,  so  easUy 
recognized  by  the  presence  at  the  nasal  angle  of  the  eye,  of  granu- 
lating masses  of  various  sizes,  proti'uding  at  their  internal  commis- 
sure of  the  lids,  and  over  the  surface  of  the  cornea,  accompanied 


DISEASES    OF    THE    MEMBRANA    NICTITANS.  743 

^th  more  or  less  suppuration,  lacrymation  and  ectropion  of  the 
lower  lid. 

The  epithelial  growths,  when  small,  will  sometimes  disappear 
under  the  appHcation  of  caustics,  or  can  be  removed  with  the 
ligature,  or  by  direct  amputation  with  fine  scissors.  In  some 
cases  they  assume  very  large  dimensions,  the  mucous  membrane 
becoming  more  or  less  ulcerated,  and  the  cartilage  itself  diseased, 
and  amputation  of  the  entire  cartilage  becoming  necessary. 

This  operation  is  not  of  recent  origin,  having  been  per- 
formed, within  our  knowledge,  some  years  ago,  though  entirely 
upon  empirical  grounds,  in  tetanic  cases,  from  the  fact  that 
the  protrusion  of  the  membrana  nictitans  over  the  inner  side 
of  the  external  surface  of  the  ocular  globe,  quite  out  of  its  nor- 
mal position,  had  often  been  noticed  among  the  symptoms  of 
lock-jaw.  The  removal  of  the  ''  hawck^''  as  the  operation  was  then 
called,  has  never,  however,  for  the  reasons  which  were  them  ac- 
cepted, become  legitimized  among  the  therapeutics  of  the  scien- 
tific veterinarian.  The  removal  of  part,  or  what  is  more  effectual, 
of  the  whole  of  the  membrana  nictitans  requires  three  instru- 
ments, a  speculum  ocuh,  a  special  forceps,  like  that  of  Snellen, 
and  a  pair  of  curved  blunt  scissors. 

The  animal  must  be  thrown,  and  the  eye  being  anestheticised 
with  cocaine,  and  the  lids  kept  well  apart  with  the  speculum,  the 
organ,  with  the  mucous  membrane  which  covers  it,  is  drawn  out 
•with  the  Snellen  forceps,  and  by  degrees  severed  in  its  continuity. 
"UTien  it  is  loosened  sufficiently  to  be  brought  entirely  out  of  the 
orbital  cavity,  it  is  separated  with  the  scissors  from  all  its  attach- 
ments. The  adipose  mass  which  was  then  slightly  i)rotruding  re- 
turns to  its  position  and  the  operation  is  concluded. 

There  is  always  a  little  hemorrhage  accompanying  the  dissec- 
tion, which,  however,  is  readily  subdued  by  means  of  a  simple 
compress  of  cold  water.  No  special  subsequent  attention  is  neces- 
sary. 

n. — Operations  on  the  Lachrymal  Apparatus. 
A. — On  the  Caruncula  A2yparatus. 
The  caruncula  lachrymalis  is  sometimes  the  seat  of  hypertro- 
phy, as  commonly  seen  in  cattle,  the  vague  designation  of  Encan^ 
this  being  given  to  all  such  lesions  of  the  caruncula  lachrymalis, 
whatever  may  be  their  origin  or  nature. 


744  OPEEATIONS  UPON  THE  EYE  AND  EAR. 

It  is  an  affection  which  is  quite  frequent  in  dogs,  as  the  result 
of  localized  chronic  conjunctivitis.  It  is  characterized  by  a  tume- 
faction of  the  organ,  more  or  less  developed,  pedunculated,  pro- 
truding in  the  inner  commissure  of  the  Hds,  and  accompanied 
by  lachrymation,  caused  by  the  obstruction  of  the  lachrymal 
punctse. 

"WTiUe  at  the  outset  anodynes  and  astringent  collyria  may  some- 
times control  its  develoj)ment,  there  are  many  cases  in  which  its 
removal  by  ligature  or  excision  is  indicated.  Silk  is  recommended 
by  Leblanc  as  the  best  material  for  a  ligature,  but  elastic  thread 
is  in  our  judgement  much  to  be  preferred. 

Excision  is  far  preferable.  The  operation  is  a  simple  one,  con- 
sisting in  merely  severing  the  peduncle  with  a  curved  scissors  or 


Fig.  535.— Bistoury  for  the  Excision  of  the  Encanthis. 

a  bistoury  (Fig.  535),  ad  hoc.  The  comparative  abundant  hemor- 
rhage that  follows  is  controlled  by  cold  water  applications.  The 
wound  which  remains  is  treated  on  general  principles. 

B. —  071  the  Lachrymal  Ducts. 

The  occlusion  or  obliteration  of  these  little  canals  by  foreign 
bodies,  or  as  the  result  of  inflammation  of  their  mucous  membrane, 
sometimes  occurs  in  horses.  Its  characteristic  symptom  is  an 
abundant  and  continual  lachrymation,  and  it  is  only  by  careful 
examination  of  the  condition  of  the  orifices  of  the  lachrymal  punc- 
tae,  that  a  correct  diagnosis  can  be  assm-ed;  a  thick,  muco-puru- 
lent  discharge  sometimes  oozing  from  them.  Though  this  diffi- 
culty often  subsides  by  resolution  of  the  inflammation,  or  the  use 
of  washes  and  collyria,  there  are  cases  where  surgical  interfer- 
ence, of  the  nature  of  a  true  catheterism  of  the  duct,  veith  joossi- 
bly  an  enlargement  of  its  canal  with  the  bistoury,  cannot  be  dis- 
pensed with.  The  probe  of  Bowmann  (Fig.  536),  and  the  knife 
of  Weber  (Fig.  537),  answer  the  purpose  very  weU. 

The  animal  is  placed  in  the  decubital  position,  the  grooved 
probe  introduced  into  the  duct,  and  its  wall  divided  with  the  knife, 
guided  by  the  groove  of  the  probe. 


THE  LACHRYMAL   APPARATUS.  745 


Fig.  536.— Probe  of  Bowmann. 


FiG.  537.— Knife  of  Weber. 
C. — On  the  Lachrymal  Canal. 

The  obliteration  of  the  lachrymal  canal  may  become  necessary 
in  consequence  of  changes  in  the  structure  of  its  walls,  or  the 
pressure  made  upon  it  by  the  surrounding  parts.  In  the  first 
case,  it  occurs  as  the  result  of  traumatic  lesions,  or  of  inflamma- 
tion of  the  mucous  membrane,  the  exudates  accompanying  it,  and 
the  accumulation  of  thick  secretions  in  the  channel  of  the  canal. 
In  the  second  case,  it  is  due  to  severe  rhinitis,  swelHng  of  the  in- 
flamed mucous  membrane  of  the  nasal  cavities,  polypi,  bony  growth 
of  any  kind,  or  in  cases  of  dental  caries. 

The  symptoms  are :  Lachrymation,  filling  up  of  the  canal,  its 
inflammation,  and  arrest  of  the  flow  of  the  tears  through  the 
lachrymal  opening  at  the  nose. 

According  to  Professor  Leclainche,  there  are  four  modes  of 
treatment  for  the  relief  of  this  trouble. 

1st.  Opening  of  the  natural  tract  and  removing  the  cause  of 
the  obstruction. — This  is  done  by  the  catheterism  of  the  canal  by 
means  of  fine  probes,  or  by  detersive  injections  forced  through 
the  inferior  opening  in  the  nostrils;  or,  again,  as  practiced  by 
Director  Trasbot,  by  insufflation. 

2d.  Making  an  Artificial  Tract. — If  the  point  of  obliteration 
is  situated  near  the  lower  opening  of  the  canal,  an  artificial  open- 
ing can  be  made  above  it.  To  do  this,  Leblanc  recommends  the  in- 
troduction of  a  whalebone  probe  through  the  superior  lachrymal 
opening  into  the  canal  until  the  place  of  obstruction  is  reached  when 
a  counter  opening  is  made  with  a  fine  bistoury  through  the  walls 
of  the  canal.  Two  or  three  silk  threads  are  then  introduced  into 
the  new  passage  between  the  two  openings  and  left  in  place  for 
about  twenty  days. 

If  the  obhteration  is  in  the  bony  portion  of  the  canal,  and 
cannot  be  overcome  with  the  silver  probe,  the  perforation  of  the 
lachrymal  bone  and  an  artificial  fistula  must  be  made. 


746  OPERATIONS  UPON  THE  EYE  AND  EAR. 

Neither  of  these  operations  is  often  followed  by  successful  re- 
sults, although  the  perforation  of  the  bone  enables  the  tears  still 
to  escape  in  the  nasal  cavities.  The  formation  of  a  fistula  fur- 
nishes a  channel  for  the  flow  of  the  tears  over  the  lachrymal  sur- 
face of  the  face. 

3d.  Ohliteratiofi  of  the  Natural  Tract. — The  intention  of  this 
operation  is  to  effect  the  entire  obUteration  of  the  duct  from  the 
lachrymal  puncta  and  the  lachrymal  duct  down.  It  is  obtained  by 
the  cauterization  of  these  parts,  either  alone  or  inclusive  of  the 
obHteration  of  the  lachrymal  sac.  Tincture  of  iodine  often  pro- 
duces the  same  effect.  As  the  result  of  this  treatment,  the  flow 
of  the  tears  takes  place  over  the  face. 

4th.  JExtirjyation  of  the  Lachrymal  Gland. — This  is  not  re- 
ferred to  as  a  practicable  measure,  but  only  because  it  is  some- 
times mentioned  in  the  way  of  theorizing.  The  situation  of  the 
gland  in  our  domestic  animals  renders  the  operation  an  impossi- 
bihty. 

m. — Operations  on  the  Essential  Organs  of  Sight. 

On  the  Globe. — The  essential  organ  of  vision,  or  ocular  globe, 
is  a  membranous  ball,  completely  closed,  and  filled  with  transpar- 
ent fluids  of  different  densities,  and  popularly  known  as  the  humors 
(or  media)  of  the  eye. 

This  baU,  nearly  spherical,  flattened  from  backwards  in  front, 
has  its  greater  convexity  in  front,  where  it  is  closed  by  the  cornea, 
a  transparent  expansion,  thick  and  resisting ;  the  glass  of  the  eye. 
Posteriorly,  it  is  composed  of  three  capsular,  concentrical  sheaths, 
proceeding  from  without  inward.  These  are  the  fibrous  sclerotic, 
the  choroid  and  the  retina  (Fig.  538). 

In  the  cavity  of  the  globe  one  of  these  membranes — the  cho- 
roid— throws  out,  perpendicularly  to  the  great  axis  of  the  organ, 
a  septum,  the  iris.,  a  kind  of  contractile  diaphragm,  perforated  in 
its  center  by  the  'pupil. 

The  retina  is  a  membrane  of  special  nature,  being  an  expan- 
sion of  the  optic  nerve,  and  performs  the  function  of  receiving 
the  impressions  of  light,  and  transmitting  its  impressions  and 
images  to  the  brain. 

The  humors  of  the  eye  are  three,  considered  from  before  back- 
ward, the  most  anterior  being  the  aqiieous,  the  most  jjosterior  the 
vitreous,  with  the  crystalline  lens  in  the  intermediate  position. 


ON    THE    ESSENTIAL    ORGANS    OF    SIGHT.  1^7 


0    c    d-  3- 


\"\1    ^ 


Pig.  538.— Theoretical  Section  of  the  Horse's  Eye. 

a.— Optic  nerve.  6.— Sclerotic,  c— Choroid.— rf.—Ketina.  «— Cornea.  /.— Iris.— 
^^.— Ciliary  circle  (or  ligament)  and  processes  given  off  by  the  choroid,  though  repre- 
sented as  isolated  from  It,  in  order  to  indicate  their  limits  more  clearly.  1— Insertior 
of  the  ciliary  processes  on  the  crystalline  lens,  j.— Crystalline  lens,  fc— Crystalline 
capsule.  Z.— Vitreous  body,  ww.— Anterior  and  posterior  chambers,  o.— Theoretical 
indication  of  the  membrane  of  the  aqueous  humor.  ^'P-— Tarsi.  (77— Fibrous  m«m- 
brane  of  the  eyelids,  r.— Elevator  muscle  of  the  upper  eyelid,  s  s.— Orbicularis  muscle 
of  the  eyelids.  <.— Skin  of  the  eyelids,  u  —Conjunctiva.  ■;;.— Epidermic  layer  of  this 
membrane  covering  the  cornea,  a;.— Posterior  rectus  muscle,  jr.— Superior  rectus 
muscle,  z— Inferior  rectus  muscle,  w  -Fibrous  sheath  of  the  orbit  (or  orbital  mem- 
brane). 

To  this  essential  organ  are  added  as  accessories,  first,  a  mus- 
■cular  apparatus,  constituted  by  seven  muscles — di posterior  straight 
or  retractor,  four  others,  also  straight,  the  superior,  inferior,  ex- 
ternal and  internal;  and  two  oblique,  or  rotators,  the  great  and 
small,  or  external  and  internal  oblique;  second,  an  adipose  pad; 
thu'd,  an  apparatus  of  lubrication,  composed  of  the  lachrymal 
gland  and  its  means  of  conducting  the  tears,  the  product  of  its 
secretion,  viz.,  the  hygrophthahnic  canals,  the puncta  lachrymalis, 
the  caruncula  lachrymalis,  the  lachrymal  ducts,  the  lachrymal 
sac,  and  the  lachrymal  canal. 

The  whole  mass  of  this  apparatus  is  enclosed  in  a  conical 
fibrous  sac,  the  ocidar  sheath,  which  forms  a  membranous  lining, 
as  it  were,  to  the  orbital  cavity,  or  bony  box,  which  is  anteriorly 
oj^en,  except  when  closed  by  the  eyelids. 

Our  design  in  the  present  chapter  is  to  confine  our  considera- 
tion entirely  to  such  portions  of  surgical  ophthalmology  as  are 
likely  to  demand  the  careful  and  practical  attention  of  the  vet- 
erinarian. 


748  OPERATIONS  UPON  THE  EYE  AND  EAK. 

A. — The  Extraction  of  Foreign  Bodies  on  the  Surface 
OF  the  Globe. 

The  presence  of  a  foreign  body  between  the  lids  and  the  globe 
of  the  eye  is  just  as  painful  to  animals  as  to  man,  and  may,  if 
allowed  to  remain,  give  rise  to  symptoms  of  irritation  and  inflam- 
mation which,  unless  promptly  relieved,  may  induce  severe  attacks 
of  diseases  which  may  compromise  the  usefulness  of  the  organ. 

Dust,  insects,  and  small  seeds  of  various  kinds  may  indeed 
find  a  lodgment  in  the  eye,  and  resist  the  efforts  made  for  their 
removal,  notwithstanding  the  excited  function  of  the  membrana 
nictitans,  or  the  super-excited  flood  of  tears  stimulated  by  their 
presence. 

Immediate  removal  is  the  first  indication.  This  may  some- 
times be  effected  by  bringing  the  lids  together  and  keeping  them 
temporarily  closed  until  the  stimulated  collection  of  tears  washes 
out  the  offending  substance. 

If  this  fails,  cocaine  must  be  apfdied  upon  the  eye,  and  when 
its  full  effect  is  obtained,  careful  examination  must  be  made,  if 
necessary,  with  the  assistance  of  a  loup,  by  everting  the  lids,  in 
order  to  bring  the  entire  surface  of  the  cornea  into  view  The 
irritating  body  may  be  wiped  out  with  the  finger,  a  piece  of  cloth, 
or  a  soft  camel  hair  brush,  or  when  the  object  is  hard  and  angu- 
lar, as  a  particle  of  metal  or  stone,  which  has  become  partly  im- 
bedded in  the  cornea,  the  forceps  may  be  necessary. 

B. — Puncture,  or  Paracentesis  of  the  Cornea. 

The  object  of  this  operation  is  to  empty  the  anterior  chamber 
of  the  eye  of  its  aqueous  humor,  of  a  collection  of  pus,  or  to  effect 
a  release  of  a  living  intruder  from  the  cavity  of  the  eye,  as,  for 
example,  the  -pax&sitic  ^/ilaria  oculi. 

The  operation  is  simple,  but  the  use  of  cocaine  cannot  be 
omitted.  The  instruments  necessary  are  a  cataract  knife,  or  a 
lanceolated  bistoury  (Fig.  539).  It  is  introduced  obliquely  through 
the  cornea,  at  a  very  short  distance  from  the  sclerotic,  and  its  in- 


FlO.  539  —Lanceolated  Bistoury. 


ON    THE    ESSENTIAL    ORGANS    OF    SIGHT.  7-!  9 

troduction  of  course  causes  the  immediate  evacuation  of  the  fluid 
contained  in  the  anterior  chamber,  and  the  dropping  or  collapsing 
of  the  cornea,  which  assumes  a  rough  and  shrunken  appearance. 
In  a  few  hours,  however,  it  resumes  its  normal  condition,  the 
secretion  of  the  humor  having  taken  place,  and  the  wound  of  the 
cornea  being  closed. 

Compresses  of  cold  water,  and  the  application  of  a  weak  solu- 
tion of  atropine  will  obviate  severe  symptoms. 

C. — Staphyloma. 

This  designation  applies  to  a  deformity  or  distension  of  the 
cornea,  consisting  in  its  protrusion  beyond  its  normal  and  sym- 
metrical convexity.  It  varies  in  shape,  and  may  be  round  or 
pointed.  It  is  very  common  in  dogs,  especially  in  young  ones, 
and  if  not  discovered  and  attended  to  in  its  first  stage  becomes 
very  rebellious  to  treatment.  If  overlooked  and  neglected  ulcera- 
tion of  the  cornea  and  destruction  of  the  eye  is  certain. 

Cauterization,  with  nitrate  of  silver,  the  ligature,  and  complete 
excision  with  the  scissors  are  recommended,  but  the  chances  of 
success  depend  on  the  length  of  time  it  has  existed  and  the  size 
it  has  attained. 

D. — Cataract. 

The  opacity  of  the  crystalline  lens,  or  that  of  its  capsule,  or 
that  of  the  humor  of  Morgagni,  or  of  these  three  conjointly,  pro- 
duces loss  of  sight,  and  for  its  re-establishment  the  operation 
called  "  of  the  cataract "  is,  in  some  exceptional  cases,  attempted 
on  horses  and  dogs. 

The  object  in  view  is  the  extraction  of  the  opaque  lens;  its 
division  into  fragments  that  may  be  resorbed ;  or  its  dislocation 
from  its  normal  position.  It  is  not  often  performed  in  veterinary 
practice,  but  successful  attempts  have  been  credited  to  Vatel,  La- 
fosse  and  others,  while  still  others,  as  Gohier,  Brogniez,  H.  Le- 
blanc,  Haubner,  Hertwig  and  Hering  have  reported  their  results 
as  sometimes  successful  and  sometimes  otherwise. 

The  animal  is  to  be  placed  in  the  deciibital  position,  and  the 
dilatation  of  the  pupil  is  to  be  obtained  by  the  application  of  a 
solution  of  sulphate  of  atropia  or  extract  of  belladonna. 

Among  the  difficulties  connected  with  this  operation  is  the 
peculiar  anatomy  of  the  globe  of  the  eye,  which  by  the  action  of 


750 


OPEEATIOXS    UPON    THE    EYE    AND    EAR. 


the  posterior  rectus  muscle  is  drawn  back  in  the  orbital  cavity,  a 
displacement  which  not  only  renders  the  action  of  the  instruments 
more  difficult,  but  also  stimulates  the  motion  forward,  over  the 
cornea,  of  the  membrana  nictitans.  The  immobility  of  the  eye  is 
one  of  the  first  points  to  be  secured.  There  are  two  ways  of 
securing  it,  one  fixing  it  from  the  front,  the  other  from  behind. 

It  can  also  be  fixed  from  the  front  in  two  ways — that  of  Le- 
blanc  and  that  of  Brogniez.  Leblanc  uses  a  tricuspid  stylet  (Fig. 
540),  which  has  three  branches,  two  of  which  are  applied  on  the 


Pig.  540.— Tricuspid  Stylet  of  Leblanc. 

sclerotic  at  the  internal  angle  of  the  eye,  the  third,  which  is  mov- 
able, resting  also  on  the  same  membrane  at  its  inferior  part.  The 
first  two  keeps  the  membrana  nictitans  from  the  cornea,  and  all 
three,  implanted  into  the  sclerotic,  keep  the  globe  immovable. 

Brogniez  uses  a  special  instrument,  which  he  calls  a  "diapta- 
tor"  (Fig.   541),  which  is  a  metallic  rod,  having  three  or  fom' 


Fig.  341.— Brogniez  Diaptator. 

points,  twisted  like  those  of  a  cork-screw,  which  by  a  shght 
pressure,  combined  with  a  little  twist  of  the  instrument,  com- 
pletely fixes  the  ocular  globe. 

To  fix  the  globe  from  behind,  Hayne,  Dieterichs,  Prinz  and 
Bleiweiss  make  an  incision  through  the  skin  behind  the  orbital 
arch,  and  an  assistant,  with  one  of  his  fingers  passed  thi'ough  it, 
keeps  it  in  place  by  du^ect  pressure. 

General  anesthesia  is  always  indicated.  Peuch  and  Toussaint 
recommend  the  use  of  the  Waldon  forceps  (Fig.  542)  to  immobil- 


FlG.  542.— Forceps  of  Waldon. 


ON    THE   ESSENTIAL    ORGANS   OF    SIGHT. 


761 


ize  the  eye.  It  operates  by  grasping  the  conjunctiva  on  the  inner 
angle  of  the  organ,  and  keeping  it  motionless  by  a  shght  pres- 
sure. The  lids  are  kept  widely  separated  by  means  of  the  specu- 
lum ocuH  already  mentioned.  There  are  three  principal  modes  of 
operation  besides  these,  which  are  used  in  human  surgery,  which 
result  in  the  union  of  these  priucipal  methods. 

1st.  Method.  Dislocation  of  the  Lens. — It  is  intended  to 
displace  the  cataract  en  masse  from  the  pupHar  focus,  and  to  fix 
it  in  a  dependent  part  of  the  chamber,  behind  the  iris,  where  it 
will  no  longer  intercept  the  light. 

It  is  generally  performed  in  two  ways — through  a  puncture  of 
the  sclerotic  (Scleroticonyxis),  or  by  puncture  through  the  cornea 
(Keratonyxis).  The  instrument  used  is  called  Scarpa's  needle 
(Fig.  543).   This  is  either  straight  or  curved.  The  eye  being  fixed, 


Fig.  543.— Scarpa's  Needles. 


and  the  pupil  dilated,  the  needle  is  introduced  through  the  scle- 
rotic, on  the  outside,  and  lower  part  of  the  globe,  a  short  distance 
back  of  the  cornea  (Fig.  544),  pushing  it  in  a  direction  first  sHghtly 
obliquely  upward,  and  then  horizontally.     The  needle  has  thus 


Fig.  544.— Operation  of  Cataract  by  Displacpment  of  the  Lens 


752  OPEEATIOKS  rPOK  THE  EYE  AND  EAR. 

penetrated  between  the  ciliary  processes  and  the  border  of  the 
lens,  and  presently  becomes  visible  to  the  operator,  passing  be- 
yond the  internal  border  of  the  pupil.  By  a  sHght  motion  up- 
ward and  downward,  the  capsule  is  then  opened  and  the  lens 
depressed,  first  backward,  then  yertically,  and  pushed  downwai-d 
into  the  lower  part  of  the  yitreous  humor.  A  gentle  rotation  of 
the  instrument  then  releases  it  from  the  substance  of  the  lens,  and 
it  is  returned  to  its  horizontal  position.  The  instrument  is  not 
withdrawn  until  it  is  ascertained  that  the  lens  is  estabHshed  in  its 
new  position. 

"When  the  puncture  is  made  through  the  cornea  the  entrance 
into  the  eye  takes  place  near  the  center  of  this  membrane,  and 
the  access  to  the  lens  takes  place  through  the  opening  of  the 
pupil. 

In  either  case  the  wound  of  the  globe  is  insignificant. 

2d.  Method.  Extraction. — There  are  two  principal  modes  of 
Ci^eration,  one  by  extraction  through  a  tiap  of  the  cornea  upward, 
and  another  by  a  linear  incision  on  the  side  of  the  globe. 

In  the  operation  by  the  fiap  iqncard,  the  knife  of  Eichter, 
modified  by  Beer  (Fig.  545),  is  introduced  horizontally  through 


Fig.  545.-Knife  of  Beers. 

the  cornea,  near  the  sclerotic  border,  a  little  aboye  the  horizontal 
diameter  of  the  globe,  with  the  edge  turned  upward,  and  as  soon 
as  the  point  of  the  instrument  has  entered  the  anterior  chamber 
of  the  eye,  it  is  pushed  in  a  straight,  horizontal  direction,  passing 
into  the  anterior  chamber  (Fig.  546),  and  when  its  point  reaches 
the  opposite  side  of  the  cornea,  it  is  pushed  through  it  in  such 
a  manner  that  its  exit  and  its  entrance  occur  at  equal  distances 
from  the  sclerotic  border. 

The  flap  is  comjDleted  by  pushing  the  instrument  directly  out, 
when  the  aqueous  humor  escapes,  and  the  cornea  collapses. 

The  anterior  waU  of  the  crystalline  coyer  is  then  divided  with 
the  kystitome  (Fig.  547).  The  hook  of  which  turns  backwai'd, 
and  is  made  to  tear  the  envelope  by  moving  it  from  above  down- 
ward and  from  within  outward.  The  upper  lid  being  raised  with 
forceps,  and  a  gentle  pressure  made  with  the  finger  at  the  lower 


ON   THE   ESSENTIAL   ORGANS   OF   SIGHT. 


753 


Fig.  546.— Operation  of  the  Cataract  by  Flap  Upward. 


Fig.  &47.— Kystitome. 

border  of  the  cornea,  the  lens  presently  falls  out  through  the  in- 
cision. If  it  becomes  engaged  in  the  wound  it  can  be  removed 
with  the  forceps  or  the  curette  of  the  kystitome. 

Unless  care  is  taken  at  this  point  to  avoid  making  too  great  a 
pressure  upon  the  eye,  there  is  danger  of  the  escape  of  the  ^^[treous 
humor.  The  Uds  are  then  brought  together  and  a  light  bandage 
appUed,  and  as  in  other  cases,  the  animal  must  be  prevented  from 
disturbing  the  wound  by  inibbing  or  otherwise. 

The  linear  method  consists  in  making  a  straight  incision  on 
the  outside  border  of  the  cornea  with  the  knife  of  Graafe  (Fig. 
548).     It  is  principally  employed  in  cases  of  soft  cataract. 


Fia.  548.— Knife  of  Graafe. 


754:  OPERATIONS   UPON   THE   EYE   AND    EAR. 

E. — Amputation  or  Extirpation  of  the  Eye. 

This  operation  is  only  indicated  in  cases  of  degeneration  of 
the  globe,  and  after  special  traumatic  lesions  of  the  organ.  It  is 
comparatively  a  simjDle  one,  and  not  as  dangerous  nor  as  painful 
as  it  is  generally  supposed  to  be.  It  can  easily  be  performed 
with  a  simple  or  a  blunt  bistoury.  Hertwig  recommends  a  sage- 
knife,  and  we  have  often  performed  it  with  only  a  pair  of  curved 
scissors. 

With  the  lids  well  separated,  the  eye,  or  what  may  remain  of 
it,  is  secured  with  a  pointed  tenaculum,  or  a  pair  of  forceps,  and 
the  conjunctiva  divided  in  all  its  circumference  with  the  knife. 
Then  passing  the  bistoury  into  the  orbital  cavity,  close  to  its 
walls,  and  cutting  from  the  inside,  and  thence  to  the  inferior  part, 
the  entire  mass  is  detached,  with  the  exception  only  of  being  held 
by  the  cord  of  the  optic  nerve. 

This  last  attachment  is  then  severed  with  the  scissors.  The 
hemorrhage  which  always  accompanies  the  operation  is  readily 
subdued  by  pressure.  Simple  cleanliness  is  all  that  is  required  in 
the  subsequent  treatment. 

Doctor  E.  Eolland  describes  his  modus  operandi  for  the  enu- 
cleation of  the  eye  as  follows:  The  operation  requires  a  specu- 
lum oculi,  a  hook  such  as  is  used  in  the  operation  for  strabismus, 
curved  blunt  scissors,  forcej)s  to  fix  the  eye,  and  a  pair  of  scissors 
curved  on  their  flat  for  the  section  of  the  optic  nerve. 

The  lids  being  held  apart  with  the  speculum  the  operator 
grasps  a  fold  of  the  conjunctiva,  on  the  outside  of  the  eye,  and 
shts  it  near  the  border  of  the  cornea.  Then,  with  the  scissors, 
the  conjunctiva  is  eutu'ely  divided  round  its  margin,  near  the 
corneal  border.  The  sub-con junctival  cellular  tissue  being  after- 
ward divided  with  the  scissors,  the  muscles  are  brought  out  with 
the  strabismus  hook  and  divided,  beginning  with  the  external 
rectus.  The  speculum  is  then  removed,  and  by  pressing  firmly  on 
both  Hds,  the  globe  of  the  eye  is  pushed  out  of  the  orbital  cavity. 
The  curved  scissors  are  passed  behind  the  globe,  and  the  optic 
nerve  amputated  at  its  i)oint  of  entrance  into  the  globe. 

The  operation  ended,  the  orbital  cavity  is  washed  out  with  cold 
sterilized  water,  and  is  then  filled  with  pulverized  and  sifted  bor- 
acic  acid.  This  dressing  is  removed  daily  for  five  or  six  days,  and 
the  eye  protected  as  in  Fig.  549. 


ON   THE   ESSENTIAIi   ORGANS   OF   SIGHT. 


755 


Fig.  549.— How  to  Protect  the  Eye. 

Ocular  Prothesis. 

The  animal  which  has  undergone  the  preceding  operation  is 
considerably  deformed,  but  the  difficulty  is  easily  remedied  by  the 
insertion  of  an  artificial  eye. 

Artificial  eyes  for  horses  were  first  introduced  by  Schmidt  in 
1850.  They  were  originally  made  of  glass,  but  many  varieties  of 
material  have  since  been  used,  and  to-day  all  instrument-makers 
probably  keep  them  in  stock,  of  hard  rubber  and  gutta-percha, 
etc.  By  the  skillful  use  of  pigments  the  artificial  organ  can  now 
be  made  to  so  closely  match  its  living  companion  as  to  be  undis- 
tinguishable  from  that  Avhich  the  animal  has  always  carried  (Figs. 
550  and  551). 

But  the  artificial  organ  must  not  be  introduced  into  the  orbital 


Figs.  550,  551.— Artificial  Eye— side  and  full  view. 


756  OPEEATIONS  UPON  THE  EYE  AND  EAK, 

cavity  until  all  granulations,  suppuration  and  inflammatory  proc- 
esses in  and  about  the  wound  have  ceased. 

To  put  the  artificial  eye  in  place  the  upper  lid  is  raised  and  the 
the  border  of  the  artificial  organ  placed  underneath  it ;  in  the 
meanwhile  the  lower  lid  is  drawn  downward  and  the  correspond- 
ing border  of  the  eye  jjushed  on  its  internal  face.  The  eye  is  in 
place,  esjDecially  if  after  its  introduction  the  animal  makes  a  few 
motions  with  his  lids,  all  the  folds  of  which  are  soon  removed. 
To  remove  the  eye  the  lower  lid  is  drawn  downward,  and  it  is  dis- 
lodged by  passing  a  blunt  probe  under  it  toward  its  posterior  face. 
The  artificial  eye  will  not  need  removal  of  tener  than  once  in  eight 
or  ten  days.  If  worn  too  long  there  might  be  danger,  with  cer- 
tain materials,  of  softening.  The  advantage  of  having  an  alter- 
nate eye  will,  upon  reflection,  become  obvious. 

ON   THE   EAR. 

Amputation. 

Usually,  only  horses  and  dogs  are  subjected  to  this  oj)era- 
tion. 

With  the  horse,  the  object  is  commonly  either  the  correction 
of  a  deformity,  or  the  cui'e  of  disease  or  injury. 

When  performed  upon  the  dog,  it  is  principally  as  an  opera- 
tion of  fashion — so-called — or  in  compliance  with  some  prevalent 
caprice  relating  to  a  supposed  improvement  in  the  appearance  of 
the  animal.  Yet  with  these  it  must  at  times,  of  course,  become 
necessary  for  the  repair  of  an  accident.  It  should  be  understood 
that  the  seat  of  the  operation  is  in  aU  cases  the  cartilage  of  the 
concha. 

Amputation  in  Horses. — The  amputation  may  be  either  partial 
or  complete.  One  ear  may  exceed  the  other  in  size,  and  it  may 
become  necessary  to  trim  down  the  larger  for  the  sake  of  estab- 
lishing symmetry  between  the  mismatched  pair  with  the  knife. 
Or  both  may  be  similarly  misshapen,  and  a  partial  amputation  of 
both  may  be,  therefore,  indicated,  for  the  same  aesthetic  reason  as 
that  which  influenced  in  the  other  case. 

This  operation  is  seldom,  if  ever,  performed  at  the  present 
time.  The  comj)lete  amputation  is  indicated  in  cases  where  the 
cartilage  is  affected  with  pathological  degenerations,  and  especially 
when  these  exist  toward  its  base. 


AMPUTATION    OF    THE    EAR. 


757 


Partial  amputation   may  be  performed  with,  the  patient  in 
any  posture,  and  may  be  considerably  simplified  by  using  Brog- 


Figs.  552,  553.— Brognlez  Apparatus  for  Amputation 
of  the  Ear. 


Fig.  554.— Apparatus  of  Brog- 
niez  in  Position. 


niez's  apparatus.  This  consists  of  a  wooden  model  of  the  inside 
of  the  cartilage  (Fig.  552),  and  of  metallic  en- 
velopes or  patterns  of  the  outside  (Fig.  553)  of 
which  there  should  be  separate  ones  for  each 
ear.  Both  the  wooden  model  and  the  metallic 
pattern  are  held  in  place  by  a  systematic  screw 
(or  wood  screw)  like  those  usen  by  cabinet-ma- 
kers in  gluing  wooden  joints  together.  The  ap- 
paratus is  adjusted  as  shown  in  Fig.  554,  and 
the  excision  of  the  protruding  cartilage  is  made 
with  the  bistoury. 

Amputation  with  the  nippers  of  Garsault 
(Fig.  555),  or  that  with  the  bistoury  do  not  give 
equally  satisfactory  results. 

Comjilete  amputation,  according  to  Peuch 
and  Toussaint,  is  best  performed  with  the  ani- 
mal under  complete  anesthesia.  We  have  had 
opportunities  of  operating  without  it,  but  it 
cannot  be  questioned  that  it  furnishes  power- 
ful assistance,  when  it  becomes  necessary  to 
keep  the  head  in  place,  as  in  this  case.  ^'^-  ^^a^sS^""'  °' 


758  OPERATIONS  UPON  THE  EYE  AND  EAR. 

We  consider  the  operation  to  be  comparatively  a  simple  one, 
though  delicate  handling  is  required. 

A  convex  bistoury  or  scalpel,  dissecting  and  artery  forceps  and 
needles  and  thread  are  the  instruments  required. 

A  circular  incision  is  made  always,  if  possible,  by  one  stroke 
of  the  knife,  toward  the  base  of  the  cartilage,  beginning  at  about 
the  lower  commissure  of  the  external  opening  of  the  concha;  then 
carefully  avoiding  the  division  of  the  bifurcation  of  the  parotid 
gland,  the  insertion  of  the  muscles  attached  upon  the  concha  is 
divided,  the  posterior  and  anterior  auricular  arteries  are  ligated, 
the  adhesions  with  the  surrounding  cellular  tissue  are  lacerated 
with  the  handle  of  the  scalpel,  and  the  ligament  which  unites  the 
concha  to  the  annular  cartilage  is  severed,  the  little  prolongation 
of  the  former  can  then  be  easily  followed  to  its  end,  and  the  con- 
cha be  readily  extirpated  b}'  lacerating  its  cellular  attachments. 

The  wound  is  closed  with  sutures,  and  treated  in  the  usual 
way. 

Amputation  in  Dogs. — Although,  as  we  have  remarked,  this  is 
principally  an  operation  of  fashion,  there  are  still  conditions  in 
which  it  is  rationally  indicated.  It  is  commonly  performed  with 
scissors,  curved  or  straight,  with  which  the  required  portions  of  the 
concha  are  amputated  by  a  single  cut  of  the  instrument. 

Instruments  have  been  invented  to  insure  a  more  certain  suc- 
cess in  the  operation,  and  a  neater  finish  after  the  wounds  have 


Fig.  556.— Nippers  to  Amputate  Dogs'  Ears. 

healed.  The  limitation  forceps,  rei^resented  in  Figure  556,  pos- 
sess some  advantages  in  these  resjDects. 

In  any  mode  of  operation,  the  flap  of  skin  first  excised  be- 
comes the  only  true  pattern  by  which  to  shape  the  second. 

The  operation  is  generally  followed  by  some  hemorrhage,  but 
this  either  subsides  spontaneously,  or  by  the  application  of  local 
hemostatics,  and  the  cicatrization  proceeds  without  help  under 
the  scab,  which  after  a  day  or  two  covers  the  edges  of  the  wound. 


CHAPTER  XV. 
DISEASES  OF  THE  WITHERS. 

The  withers  is  the  region  of  the  body  which,  of  all  others,  is 
most  exposed  to  lesion,  the  injuries  to  which  it  is  subject  being  of 
every  form,  nature  and  degree  of  severity.  From  its  very  loca- 
tion it  is  esiDecially  Hable  to  all  kinds  of  external  traumatisms,  and 
is  peculiarly  apt  to  suffer  from  blows,  bruises,  bites,  contusions, 
pressures  and  frictions  by  the  harness,  etc.,  and  these  giVe  origin 
to  bloody  or  serous  tumors ;  cold  and  warm  oedemas,  abscesses 
superficial  or  deep,  and  various  wounds  of  the  surface,  with  or 
without  injuries  of  the  subjacent  tissues;  and  these  again  may  be 
followed  by  necrosis  of  the  dorso-cervical  ligament,  and  of  the 
apex  of  the  dorsal  vertebrae,  accomjDanied  with  purulent  filtrations, 
in  various  localities,  the  formation  of  fistulous  tracts,  and  possibly 
the  extenston  of  the  diseased  conditions  to  the  ligamentum  nuchse, 
ending  with  the  disease  of  the  neck,  with  all  its  unfortunate 
sequelae. 

With  the  consideration  of  such  a  multiphcity  of  pathological 
evils  before  us,  an  orderly  and  systematic  arrangement  of  topics 
is  especially  necessary,  and  we  shall,  therefore,  in  our  treatment 
of  the  diseases  of  the  withers,  adopt  the  classification  of  Bouley 
dlid  Nocard.  And  this  introduces  us  successively  to  the  study 
of  excoriations,  cedemas,  hemato')na,  core  or  stickfasts,  cysts, 
abscesses,  wotinds,  and  the  "diseased  withers''^  proper,  or  what  is 
generally  understood  as  "the  persisting  lesion,  fistulous  in  its 
character,  and  whose  condition  of  formation  and  duration  is 
due  to  the  mortification  of  the  fibrous,  yellow  or  cartilaginous 
tissue  of  the  ajjex  of  the  spinous  processes  of  the  anterior  dorsal 
vertebrae." 

Considered  from  an  anatomical  point  of  view,  the  withers  form 
a  very  complex  region.  Its  skeleton  is  formed  by  the  superior 
spinous  processes  of  the  anterior  dorsal  vertebrae,  and  it  is  sur- 
rounded by  muscles  arranged  in  layers,  intersected  by  fibrous 


760 


DISEASES    OF    THE    WITHERS. 


aponeurotic  bands  or  slieaths.  The  vertebrae  give  attachment 
by  the  cartilaginous  nucleus,  which  is  at  their  apex,  to  the  pos- 
terior portion  of  the  yellow,  elastic  cord,  which  is  part  of  the 
funicular  portion  of  the  hgamentum  nuchae,  and  are  also  united  by 
the  interspinal  ligament.  The  muscles  which  rest  upon  the  ver- 
tebrae form  six  different  planes,  thus  divided :  1st.  The  skin,  lined 
inside  by  cellular  tissue,  more  condensed  toward  the  median  line 
than  on  the  sides,  where  it  is  loose ;  2d.  The  trapezimn  muscle, 
thin  and  aponeurotic  inferiorly,  but  thicker  in  its  upper  portion, 


Fig.  557.— 1st  and  2d  Layers  of  the  Eegion  of  the  Withers. 
P.— Skin  folded  down,    pf.— Funicular  portion  of  the  cervical  ligament,    to. —Cer- 
vical portion  of  the  trapezium,    td.— Dorsal  portion  of  the  same,    ea.— Acromion  spine 

which  is  muscular  (Fig.  557),  and  lying  over  the  external  surface 
of  the  scaj)ula  and  its  cartilage  of  prolongation.  3d.  The  rhom- 
boideus  muscle,  which  is  separated  from  the  second  plane  on  its 
external  siu'face  by  a  layer  of  loose  cellular  tissue  (Fig.  558),  and 
is  lined  in  its  internal  face,  by  a  yellow  elastic  band,  inserted  on 
the  inside  face  of  the  cartilage  of  prolongation  of  the  scapula. 


DISEASES    OF    THE    WITHEES. 


761 


Fig.  558.-33  Layer  of  the  Region  of  the  Withers, 
cb. — Cartilage  of  the  scapula,      pf. — Funicular  portion  of  the  cervical  ligament, 
rh.— Rhomboideus  muscle,    a.— Angularis  of  the  scapulse.    S.— Splenius. 


Fig.  559.— 4th  Layer  of  the  Withers, 
sc. — Section  of  the  scapula  and  surrounding  muscles,  da. — Anterior  small  serratus. 
ap.— Its  aponeurosis,  gd.— Great  serratus.  pf.— Funicular  portion  of  the  cervical  lig- 
ament, s. — Inferior  attachment  of  the  splenius.  ad. — Kamiflcations  of  the  dorsal 
artery,  gc. — Gre&t  complesus.  pc— Small  complexus.  a. — Section  of  the  angularis 
BcapulsB. 


762 


DISEASES    OF    THE    WITHEKS. 


This  band  is  specially  liable  to  attacks  of  necrosis.  4tli.  The  su- 
perior portion  of  the  anterior  small  serratus  muscle,  wliicb  is 
formed  by  a  broad  aponeui'osis,  attached  to  the  superior  extrem- 
ity of  the  spinous  processes  of  the  vertebrae  (Fig.  559).     5th.  The 


Pig.  560.— 5th  Layer  of  the  Withers, 
pi.— Lamellar  portion  of  the  cervical  ligament,  pf.— Funicular  portion  of  the  same, 
ac— Superior  cervical  artery,  te.— Transversal  spinous  of  the  neck,  bs.— Superior 
branch  of  the  spinalis,  bl.— Inferior  branch  of  the  same  muscle,  ic— Common  inter- 
costal, ad.— Dorsal  artery,  gd.— Great  serratus.  si.— Inferior  scalenus,  it  — Inter- 
transversalis  muscle. 

anterior  portion  of  the  iUo-spmalis  muscle  (Fig.  560).  The  6th 
and  the  deepest  of  these  planes,  resting  on  the  faces  of  the  long 
spinous  processes  of  the  vertebrJB,  is  formed  by  the  trayisverse 
spinal  muscle  of  the  back.  (Fig.  561).  To  these  are  to  be  added 
the  posterior  extremities  of  some  of  the  muscles  of  the  neck, 
covered  by  the  internal  face  of  the  scapula,  the  ramification  of 
the  large  blood  vessels,  branches  of  the  anterior  aorta,  and  the 
dorsal  and  superior  cervical  artery  with  the  spinal  nerves  which 
are  distributed  in  that  portion  of  the  body.  If  we  majD  all  this 
distinctly  in  our  minds,  we  shall  have  the  material  for  forming  an 
idea  of  the  structure  of  the  withers,  and  the  intricate  and  inter- 
estiug  arrangement  and  disposition  of  its  many  parts,  with  their 
relation  to  the  ailments  which  attack  them.  This  will  be  facilitated 
by  an  inspection  of  the  illustration  (Fig.  562),  representing  a 
transverse  section  of  the  entire  region  involved.  The  drawing 
exhibits  the  obliquity  of  the  direction  of  the  various  muscular 
layers,  and  demonstrates  the  tendency  of  the  purulent  gatherings, 
by  gravitating  and  collecting  between  them,  to  contribute  to  the 


DISEASES    OF    THE    WITHERS. 


763 


Fig.  561.— 6th  Layer  of  the  Withers, 
pi.— Lamellar  portion  of  the  cervical  ligament,  pf.— Funicular  portion,  te.— Trans- 
verse spinalis  of  the  necli.  ac— Spinous  processes  of  the  dorsal  vertebrsB.  t.— Tuber- 
osities of  the  same,  te.— Transverse  spinalis  of  the  bacli.  ie.— Common  intercostal, 
c— Ribs,  gd.— Great  serratus.  it.— Inter-transversalis.  i.— External  intercostal  mus- 
cle.   1. — Inter-spinalis  ligament. 

formation  of  the  ailment  recognized  as  a  true  "  diseased  withers," 
with  the  habitual  severity  which  is  its  characteristic. 

The  originating  causes  of  the  diseases  of  the  withers  may  be 
divided  into  the  2:>redisposlng  and  the  occasional.  Among  the 
first  are  to  be  noted  a  defective  anatomical  conformation  of  the 
region;  the  kind  of  work  performed  by  the  animal,  and  the  degree 
of  care  he  receives.  For  exami:)le,  when  the  withers  are  low,  thick 
and  fleshy,  as  in  heavy  draught  horses,  the  saddle  of  the  harness 
has  a  tendency  to  slij)  forward  and  cause  chafing  and  excoriation, 
an  accident  from  which,  however,  animals  with  high,  sharj?  withers 
are  by  no  means  exempt ;  for  though,  for  the  reason  stated,  they 
are  less  liable  than  those  of  the  other  conformation,  the  advantaga 
is  offset  by  the  fact  that  the  skin  is  exj^osed  to  a  more  unequal 
pressure,  especially  if  that  j^art  of  the  harness  is  not  properly 
padded  and  fitted,  and  presses  irregularly  on  the  soft  tissues, 
upon  which  it  rests. 


764: 


DISEASES   OF   THE  WITHEBS. 


Fig.  562.— Transverse  Section  of  the  Eegion  of  the  Withers, 
p.— Skin,    fe.— Fibre  elastic  tissue,    t.— Dorsal  trapezium,    r.— Rhomhoid  muscle, 
•cp.— Cartilage  of  the  scapula,    is.— Ilio  spinalis,    v.— 5th  dorsal  vertebra,    gd.— Great 
serratus.      ss.  —  Sub-scapularis.      s.— Scapula,      se.  —  Antea-spinatus.     sh.— Scapulo- 
humeral joint,    pf.— Deep  pectoral,    pt.— Thoraciq  walls. 

Saddle  horses  are  for  the  same  reason  peculiarly  apt  to  become 
sufferers  from  the  lesion  of  which  we  are  sj^eaking.  The  self- 
inflicted  bites  and  the  scratching  and  rubbing  of  animals  suffering 
from  parasitic  affections,  in  their  efforts  to  relieve  themselves,  may 
also  result  in  placing  them  in  the  category  of  the  predisposed. 

To  enumerate  all  the  occasional  causes  would  be  to  make  a 
catalogue  of  casualties,  which  would  be  best  done  by  copjdng  from 
the  accident  columns  of  the  daily  press,  and  we  shall  merely  refer 
to  a  few  of  a  kind  which  may  possess  some  sj^ecial  characters  and 
notable  features,  not  too  obvious  or  common  and  familiar 

Contusions  of  any  kind,  resulting  from  the  causes  stated,  or 
even  little  abrasions  from  the  simple  misfit  of  a  blanket  kept  in 
place  by  a  surcingle  too  tightly  buckled — anything,  in  fact,  which 
may  give  rise  either  by  its  immediate  effect  or  by  its  continuance. 


DISEASES    OF    THE    WITHERS.  765 

to  the  slightest  form  of  pathological  change,  may  serve  as  a  spark 
which  may  kindle  into  the  most  serious  case  of  fistulous,  diseased 
withers. 

(a)  JSxcoriation. — This  is  the  simplest  of  the  lesions  of  the  skin 
covering  the  withers,  or  any  j)ortion  of  the  body.  It  is  most  com- 
mon in  summer,  when  it  appears  in  the  form  of  a  red  si^ot,  becom- 
ing rapidly  covered  with  an  abundant  serous  exudation,  which 
rapidly  forms  a  yellow  or  brownish  crust,  adherent  to  the  under- 
lying tissues.  This  is  always  painful,  especially  in  summer,  when 
it  excites  a  violent  f>ruritis,  which  may  degenerate  into  a  lesion 
of  a  serious  nature. 

Excoriations,  however  simple,  ought  never  to  be  neglected,  and 
precautions  should  always  be  taken  against  them.  When  they  do 
occur,  local  healing  applications,  usually  simple  ones,  are  sufficient, 
and  should  be  made  without  delay. 

(b)  Wann  (Edema. — This  is  the  result  of  the  laceration  of 
the  subcutaneous  cellular  tissue  and  its  subsequent  inflammation. 
Saddle  horses  suffer  from  it,  especially  in  summer  and  after  long 
jom-neys.  At  such  times,  the  skin  becoming  more  or  less  adher- 
ent to  the  saddle,  the  motion  of  the  animal,  together  with  that 
of  the  skin,  is  communicated  with  every  step  to  the  subjacent 
cellular  tissue  (a  sort  of  rubbing,  to-and-fro  motion) ;  and  this  vio- 
lence, though  slight,  produces  by  its  long  continuance  the  natural 
effect  of  inducing  an  inflammatory  state  in  the  tissue.  This 
oedema  is  characterized  by  a  tumefaction  of  the  parts,  warm  and 
pitting  under  pressure,  more  or  less  painful,  and  having  a  tendency 
to  sj^read  toward  dependent  structures.  It  disappears  by  resorp- 
tion in  two  or  three  days,  but  leaves  a  slight  thickening  of  the 
cellular  tissue,  sometimes  difficult  to  detect.  This  resorption 
takes  place  if  the  originating  cause  has,  within  a  moderate  period, 
ceased  to  operate ;  but  if,  on  the  contrary,  it  has  been  permitted 
to  keep  up  its  u-ritating  action,  the  oedema  will  increase,  and  in 
due  time  the  condition  will  be  changed  to  that  of  suj^puration, — a 
termination  to  be,  if  possible,  by  all  means  anticipated  and  pre- 
vented. 

The  removal  of  the  cause,  sometimes  accomplished  by  merely 
giving  the  patient  a  season  of  rest,  is  the  most  important  item  in 
the  treatment.  The  resoi'j^tion  of  the  oedema  can  be  accelerated 
by  means  of  massage,  cold  compresses,  astringent  lotions,  weak 
stimulating  frictions  of  an  alcoholic  nature,  or  cold  irrigations. 


766  DISEASES    OF    THE    WITHERS. 

(,c)  Hematoma,  or  Bloody  Tumor. — This  lesion  is  produced 
by  a  violent  traumatism,  such  as  a  blow,  a  contusion,  or  a  violent 
bite  by  some  other  animal.  It  develops  immediately  upon  the  oc- 
currence of  the  cause,  resulting  from  the  laceration  of  the  super- 
ficial blood  vessels.  '  It  is  characterized  by  a  swelling,  vai-ying  in 
size  according  to  the  nature  of  the  producing  cause.  It  is  at  first 
somewhat  warm  and  fluctuating,  then  becoming  puffy,  and  when 
the  blood  has  coagulated,  hard,  tense  and  crepitating.  Ordinarily 
it  is  not  very  warm  or  painful,  but  it  becomes  so  after  a  few  hours, 
and  then  there  is  danger  of  its  assuming  a  supiDiu-ative  character. 
Yet  in  other  cases  it  may  maintain  that  condition  for  two  or  three 
weeks,  undergoing  the  process  of  resolution,  the  resorption  usually 
becoming  complete  in  that  period.  The  correct  diagnosis  of  this 
condition,  and  of  any  occurrent  changes,  some  of  which  it  is  im- 
portant to  know,  can  be  more  satisfactorily  established  by  explor- 
ation. 

Left  without  interference  and  in  the  absence  of  irritating  causes, 
the  hematoma  w^ill  usually  subside  by  spontaneous  action.  In  their 
treatment,  cold  applications  are  indicated  during  the  first  days  of 
its  existence,  but  at  a  later  period,  when  the  tumefaction  has  be- 
come of  a  denser  consistency,  absorbent  and  stimulating  local 
medication  is  indicated,  such  as  blisters  of  cantharides,  or  of  mer- 
curial preparations,  or  of  the  iodine  compounds.  These  applica- 
tions, however,  must  not  be  too  hastily  resorted  to,  lest  the  exces- 
sive or  premature  stimulation  should  end  in  the  formation  of 
abscesses.  Except  when  there  is  positive  evidence  of  supj)uration, 
pressure  by  bandaging  and  the  opening  of  the  tumor  with  the 
bistoury  are  always  contra-indicated. 

{d)  Gore,  or  Stickfast.  —  This  is  caused  by  the  immediate 
mortification  of  a  portion  of  the  skin,  and  often  of  the  deej^er 
tissues.  It  is  a  hairless  scab  of  a  blackish  color,  having  the  ap- 
pearance of  tanned  leather.  It  is  at  times  superficial,  and  has  a 
tendency  to  extend  to  the  subjacent  structures.  It  is  rigid  and 
inflexible,  and  its  j)ressure  upon  the  deeper  tissues  tends  to  in- 
crease mortification.  The  tissues  surrounding  it  are  inflamed  and 
their  sensibility  increased,  and  at  a  later  period  a  j^rocess  of  elim- 
ination by  suppuration  takes  place  all  around  its  edges.  But  this 
pus  does  not  very  readily  escape,  and  there  is  always  a  j^ortion 
remaining  in  the  bottom  of  the  sloughing  surface  which  becomes 
fistulated  with  the  formation  of  collections.     If  the  core  should 


DISEASES    OF    THE    WITHERS.  767 

extend  to  the  dorsal  ligament  or  to  tlie  bones,  the  result  will  be 
necrosis  and  caries,  and  a  true  diseased  wWier  will  be  the  conse- 
quence. With  these  conditions,  lymphangitis,  leucophlegmasia, 
and  deep  abscesses  may  be  expected,  and  usually  supervene. 

The  sloughing  of  the  mortified  structure  is  always  slow,  espe- 
cially when  the  deeper  tissues  are  involved,  but  the  wound  which 
remains  after  the  casting  off  of  the  core  is  not  uniform  in  its  sub- 
sequent action.  When  it  is  superficial  it  heals  quite  rapidly,  but 
recovers  only  with  great  difficulty  when  it  is  deep-seated,  and  in- 
volves fibrous,  cartilaginous  and  bony  structures. 

The  prognosis  of  this  lesion  of  the  withers  varies  according  to 
the  thickness  of  the  tissues  which  are  involved ;  but  it  also  varies 
according  to  its  location,  those  which  are  situated  on  the  lateral 
faces  of  the  withers  being  less  serious  than  those  which  occur  on 
the  median  line. 

The  treatment  indicated  is  strictly  local.  The  first  indication 
is  to  discontinue,  or  obviate,  the  irritating  cause,  by  changing 
the  harness,  by  chambering  it,  or,  what  is  better,  by  refraining 
from  working  the  animal  until  he  has  entirely  recovered.  The 
second  indication  is  to  hasten  the  sloughing  of  the  mortified  tis- 
sue, and  allay  the  irritability  which  the  animal  betrays  upon  the 
slightest  touch  of  the  hand,  or  other  object,  upon  his  back.  Top- 
ical remedies  in  the  form  of  ointments,  lotions  or  poultices,  are  in- 
dicated for  this  purpose.  As  soon  as  the  process  of  sloughing 
begins  it  must  be  stimulated  and  encouraged.  Warm  comj)resses, 
antiseptic  lotions,  glycerine,  phenial  mixtures  are  then  beneficial. 
The  maintenance  of  simple  moisture,  by  means  of  phenicated  or 
creolined  mixtiu-es  has,  in  our  own  experience,  been  of  great  ad- 
vantage. If  during  the  process  of  the  elimination  of  the  core  the 
suppuration  seems  to  be  abundant  with  a  tendency  to  accumulate 
instead  of  escaping,  care  must  be  taken  to  facilitate  its  removal 
by  means  of  oakum,  absorbing  cotton,  sponges  or  drainage 
tubes.  Sometimes  the  core  is  of  unusual  size,  with  roots  reaching 
deeply  into  the  tissues  beneath,  but  although  this  may  be  the 
case,  no  attempt  should  ever  be  made  to  tear  them  forcibly  away. 
They  must  be  permitted  to  drop  away  by  spontaneous  action.  If 
the  edges  are  very  wide  they  may  be  trimmed  off  with  the  scissors 
or  bistoury,  but  interference  beyond  this  is  never  permissible. 
When  they  have  entirely  sloughed  away  there  remains  but  a  simple 
granulating  wound,  which  ordinarily  requires  but  mild  forms  of 


768  DISEASES  or  the  withers. 

treatment.  The  animal,  however,  ought  not  to  be  made  to  re- 
sume work  until  it  is  entirely  healed. 

(e)  Cyst,  or  Hygroma. — These  terms  designate  a  tumor  which 
usually  forms  on  either  the  middle  or  the  lateral  face  of  the 
withers,  originating  in  the  dropsical  condition  of  a  serous  bursa. 
On  whatever  part  of  the  withers  it  may  make  its  appearance,  the 
originating  cause  is  the  same,  and  it  is  the  effect  of  friction,  or  of 
the  slight  but  long-continued  irritation  produced  by  an  ill-fitting 
harness,  inflicted  while  the  animal  is  suffering  from  parasitic  dis- 
eases. In  these  cases  the  connective  areolae  of  the  bursa  become 
the  seat  of  an  amount  of  secretion  in  excess  of  that  which  is  re- 
moved by  the  act  of  resorption,  and  the  accumulated  hyper- 
secreted  fluid  gathers  into  the  cavity,  to  form  the  serous  cyst. 

When  located  in  the  median  line,  the  hygroma  constitutes  a 
soft  tumor,  of  varying  size,  from  that  of  a  pigeon's  egg  to  that  of 
a  child's  head — bilobulated,  always  soft,  fluctuating,  without  heat, 
and  painless ;  even  transparent,  when  the  skin  is  pigmentless.  It 
always  presents  the  differential  characters  of  being  well  defined 
in  its  outlines,  and  without  inflammatory  perij)herical  infiltra- 
tion. 

When  the  cyst  is  on  the  side  of  the  withers  it  may  present 
some  similar  characters,  but  when  it  is  deep,  under  the  apone- 
urosis of  the  trapezium,  or  even  under  the  rhomboideus,  an  ex- 
ploration becomes  necessary  to  establish  the  differential  diagnosis 
from  abscess,  as  upon  the  true  nature  of  the  tumor  depends  the 
immediate  indications  of  treatment. 

Hygroma  of  the  withers  may  retain  their  characteristics  for  a 
long  time,  but  many  change  in  their  nature  under  the  influence 
of  external  irritations,  bruises,  contusions,  improper  treatment, 
etc.  In  that  case  the  cyst  is  transformed  into  an  abscess,  or  rather 
a  suppurating  cyst. 

In  respect  to  the  treatment  of  cystic  withers,  the  first  indica- 
tion is  to  remove  the  cause,  and  with  this  not  only  will  the  accu- 
mulation of  the  serosity  cease,  but  the  possibility  of  its  trans- 
formation into  the  abscess  form  will  be  removed. 

When  the  cyst  is  small  and  of  recent  formation,  resolvent 
treatment  is  in  order,  as  cantharides  ointment,  bichloride  or 
biniodide  of  mercury  pomatums,  etc.  Actual  cauterization,  in  lines 
or  in  points,  has  given  satisfactory  results  in  chronic  cases.  In- 
jections of  tincture  of  iodine  have  also  been  recommended.     Our 


DISEASES    OF    THE    WTCTHERS.  769 

own  experience  warns  us  that  it  is  not  without  danger,  from  its 
habiUty  to  be  followed  by  a  severe  form  of  diseased  withers. 
Bouley  and  Nocard,  in  relation  to  this  mode  of  treatment,  say  "it 
is  better  to  empty  the  cyst  with  a  capilliary  trocar,  or  by  the 
aspirator,  to  wash  its  cavit}^  with  an  antiseptic  preparation,  slightly 
irritating  (5  per  cent,  solution  of  phenic  acid),  to  repeat  this  injec- 
tion several  times,  until  the  liquid  taken  out  of  the  cyst  is  per- 
fectly limpid,  and  then  apply  over  the  entire  surface  of  the  skin  a 
thick  coat  of  blister." 

The  purulent  cyst  is  treated  as  an  abscess. 

{f)  Abscess. — A  phlegmon  of  the  withers  may  rise  suddenly 
under  the  influence  of  a  severe  traumatism,  or  become  the  sequel 
of  a  hematoma,  or  of  a  cyst.  It  appears  most  commonly  on  the 
superior  part  of  the  withers ;  sometimes  on  the  sides,  as  a  tumor 
more  or  less  warm  and  painful,  first  uniformly  hard  and  tense, 
and  afterward  soft,  with  a  fluctuating  center,  and  surrounded  b}'' 
an  oedematous  infiltration,  more  or  less  developed.  If  the  abscess 
is  superficial,  ulceration  of  the  skin  soon  takes  place,  followed  by 
the  escajDC  of  thick,  white  and  creamy  pus. 

If,  on  the  contrary  (and  this  is  often  the  case),  the  abscess 
is  deep,  developing  itself  under  the  the  aponeurosis  of  the  great 
dorsal,  or  of  the  rhomboideus  muscle,  or  even  deeper,  under  the 
cartilage  of  the  scapvila,  or  the  thickness  of  the  ilio-si^inahs,  the 
symptoms  then,  however,  being  less  defined.  The  tumefaction  is 
less  characteristic,  the  heat  less  marked,  the  fluctuation  not  detect- 
able, and  the  only  sign  which  guides  the  surgeon  is  the  excessive  pain 
manifested  upon  the  slightest  ^pressure  on  the  tumor,  and  from 
which  the  animal  shrinks  in  fear.  This  soreness  is  in  fact  so  great 
that  in  some  animals  it  interferes  with  the  action  of  the  leg  on  the 
side  affected.  The  appearance  of  general  febrile  symptoms  is  not 
uncommon  at  this  period,  with  elevation  of  temperatui-e,  increase 
in  the  circulation,  anorexia,  excessive  thirst,  etc.  At  this  period, 
also,  it  becomes  important  to  be  certain  of  the  diagnosis,  or  at 
least  to  be  sure  of  the  existence  of  the  sui^puration,  and  its  loca- 
tion must  be  accurately  made  out,  in  order  to  prevent  the  severe 
disorders  that  may  be  caused  by  the  presence  of  the  pus  ;  a  prob- 
lem which  can  be  only  solved  by  repeated  capillary  exploring 
punctures,  made  at  various  points,  and  at  given  depths,  according 
to  the  dimensions  of  the  phlegmonous  enlargement. 

The  prognosis  of  abscess  of  the  withers  depends  altogether  on 


770  DISEASES   OF    THE   WITHERS. 

the  seat  it  occupies.  If  superficial,  and  on  the  lateral  faces  of  the 
region,  it  is  not  serious.  If  on  the  median  line,  it  assumes  a  more 
severe  character.  If  deep,  it  is  also  of  a  dangerous  nature,  unless 
it  is  simi^le  or  Hmited;  but,  on  the  contrary,  if  the  quantity  of  the 
pus  has  continued  to  increase,  and  infiltration  has  taken  place  into 
the  cellular  tissue  separating  the  muscular  laj^ers  ;  or  the  sup- 
puration has  penetrated  under  the  cartilage  of  the  scapula;  it 
wni  have  assumed  the  most  complicated  form  of  the  disease,  with 
chances  of  recovery  of  a  very  doubtful  character.  "When  the  pres- 
ence of  the  pus  has  been  detected,  the  immediate  indication  is  to 
assist  its  discharge  by  a  free  incision  down  to  the  bottom  of  the 
cavity.  The  incision  must  be  made  on  the  most  dependent  part 
of  the  tumor ;  in  such  manner  as  to  prevent  the  collection  from 
settling  in  a  cul-de-sac.  A  means  of  drainage  must  be  provided, 
and  the  tube  is  preferred  to  the  tent  of  oakum,  or  even  to  the 
seton,  as  more  sure  to  reach  all  parts  of  the  collection,  and  the 
more  thoroughly  to  wash  out  the  cavity. 

Jf,  however,  the  suppuration  has  not  been  detected,  the  appli- 
cation of  local  stimulation  is  indicated  by  means  of  warm  com- 
presses, hot  poultices  and  the  like  ;  a  constant  watchfvdness  being 
maintained,  meanwhile,  in  order  to  detect  the  presence  of  the  pus 
at  the  earhest  moment  of  its  formation  ;  when  it  must  be  immedi- 
ately evacuated. 

{9)  Wounds. — Kesulting  from  every  variety  of  traumatic 
agencies,  these  injuries  will  necessarily  vary  ia  their  extent  and 
the  nature  of  the  tissues  which  are  involved. 

They  therefore  extend  from  the  most  trifling  hurt  of  the  skin 
to  the  severest  lacerations  of  the  important  ligamentous,  cartila- 
ginous and  bony  structures  contained  in  the  region  under  con- 
sideration. With  such  a  diversity  in  their  form  and  nature  there 
must  also  be  a  corresponding  range  in  the  character  of  the  prog- 
nosis to  be  announced,  from  that  of  rapid  spontaneous  recovery, 
without  interference,  to  the  gravest  of  terminations. 

One  of  the  principal  indications  in  the  treatment  of  woimds  of 
the  withers  is  to  prevent  as  much  as  possible  the  filtration  and 
deposit  of  pus  through  the  various  layers  of  the  region,  and  facih- 
tate  the  cicatrization,  by  placing  them  in  a  state  of  immobihty, 
and  according  to  Bouley  and  Nocard,  the  best  method  of  secirring 
this  suspension  of  movement  is  to  apply  a  broad  bhster  all  around 
the  wound,  and  to  repeat  the  appHcation  after  a  few  days.     The 


DISEASES    OF    THE    WITHERS. 


i71 


pain  caused  by  this  compels  the  animal  to  abstain  from  all  move- 
ment, and  besides  this  the  inflammatory  swelling  resulting  from 
the  bhster  promotes  the  cicatrizing  process  by  stimulating  the 
proHferation  of  the  cells  of  the  repairing  tissue.  Aside  from  this 
special  direction,  the  treatment  of  wounds  of  the  withers  involves 
no  methods  or  indications  different  from  those  of  similar  hurts  in 
other  parts  of  the  body.  In  most  cases  the  surgeon  must  trust 
his  experience  and  knowledge  of  general  principles  for  guidance. 

(A)  ''Diseased  Withers'' 2^^'02Jer:  Fistulous  Withers.— k^  \fe 
have  before  stated,  this  denomination  belongs  to  "  a  persisting 
lesion,  fistulous  in  character,  due  to  the  mortification  of  the  tis- 
sues of  the  withers,  fibrous,  yellow,  cartilaginous  or  bony."  It  is 
necrotic  in  its  nature,  and  while  ii  may  attack  but  one,  it  may 
also  exist  in  all  of  these  organs. 

Whatever  this  condition  may  be,  however,  the  necrosis  is  always 
manifested  externally  by  an  indicator,  in  the  form  of  a  fistula  giv- 
ing exit  to  an  abundant,  thin  pus,  serous,  sanious,  grayish  in  color, 
adhering  to  the  haii%  and  irritating  and  excoriating  the  skin  upon 
which  it  flows.  At  first  it  is  odorless,  and  nearly  homogeneous, 
but  it  soon  becomes  foetid  in  odor  and  loaded  wdth  the  detritus  of 
necrotic  tissues,  more  or  less  abundant,  varying  in  thickness  and 
in  color,  according  to  the  nature  of  the  tissue  from  which  it  is 
formed. 

One  or  several  of  these  fistulous  openings  may  exist  on  one  or 
both  sides  of  the  withers  leading  from  the  same  or  from  different 
necrotic  centers.  Their  number  is  not  limited.  Several  of  them 
may  be  in  existence  at  the  salne  time,  especially  when  the  disease 
has  maintained  its  hold  on  the  system  for  a  period  of  three  or 
four  months  without  being  checked  or  cured ;  a  state  of  things 
not  infrequently  witnessed. 

Their  formation  is  explained  by  the  constant  accumulation  of 
the  pus  in  the  sinuosities  of  the  original  tract,  which  by  degrees 
overcomes  the  resistance  of  the  surrounding  structures,  and  es- 
tablishes a  channel  for  itself  by  the  same  process  as  that  by 
which  the  first  outlet  was  formed.  It  may  sometimes  happen  that 
the  opening  of  new  canals  becomes  the  cause  of  the  closure,  or 
perhaps  only  the  constriction,  of  the  original  channel,  and  a  new 
exploration  becomes  necessary  to  ascertain  the  new  routes  of  the 
fluid.  In  this  case  their  direction  will  be  best  made  out  by  the 
injection  of  liquids  through  their  open  mouths. 


772  DISEASES    OF    THE    WITHEES. 

The  presence  of  one  of  these  canals  at  the  bottom  of  a  wound 
may  sometimes  he  detected  by  the  appearance  of  large,  fleshy, 
cone-shaped  granulations,  of  a  pm-phsh  color,  from  which  an  ooz- 
ing of  pus  takes  place  upon  the  application  of  pressure. 

But  in  another  case,  the  orifice  of  the  fistula  may  be  directly 
on  the  skin,  surrounded  with  granvdations,  protruding,  soft  and 
bleeding  upon  the  shghtest  touch,  with  an  escape  of  sanious  pus 
between  them ;  these  granulations  at  a  later  period,  flattening,  as 
the  wound  contracts,  until  the  thinned  skin  seems  to  be  continu- 
ous with  the  smooth,  reddish  membrane  which  lines  the  internal 
face  of  the  tract.  It  may  even  happen  that  a  process  of  cicatriza- 
tion taking  place  around  the  opening  will  transform  its  external 
outlet  into  a  narrow  strait  which  opens  in  the  bottom  of  a  cavity 
formed  by  the  skin  drawn  inwardly  by  the  cicatricial  retraction  of 
the  indurated  peri-fistulous  tissue. 

The  direct  exploration  of  the  fistula  is  the  best  mode  of  ascer- 
taining its  existence,  direction,  extent  and  depth,  and  also  the 
lesion  which  gives  rise  to  it.  This  exploration  ought  to  be  made 
by  the  taxis,  since  it  is  obvious  that  no  instrument  can  communi- 
cate an  impression  such  as  can  be  obtained  by  the  touch  of  the 
finger.  By  the  hand,  therefore,  must  be  ascertained  the  course 
and  sinuosities  of  the  fistula,  its  diverticulum,  the  nature  of  the 
necrosed  tissue,  and  the  extent  of  the  mortification.  But  this 
manual  exploration  is  not  always  possible,  either  because  of  the 
deficient  caliber  of  the  passage,  or  of  its  sinuosity,  or  its  length. 
Kesort  must  be  had  to  the  various  probes  and  directors  in  use. 

When  the  necrosis  occupies  the  apex  of  one  or  more  of  the 
spinous  processes,  and  the  fistvila  is  superficial,  a  slight  incision 
will  expose  the  diseased  spot  to  ocular  inspection,  and  the  condi- 
tion of  things  may  be  at  once  fully  reahzed.  When  the  lesion  is 
limited  to  the  cervical  ligament,  the  eschar  or  slough  will  have 
an  olive-greenish  color,  and  will  be  of  soft,  pultaceous  consistency, 
with  a  pecvdiar  foetid  odor,  from  its  maceration  in  the  pus.  If 
the  necrosis  has  attacked  the  cartilages  of  the  vertebrse,  the  morti- 
fied part  assumes  a  yellow  color,  with  a  tint  of  pale  green.  In 
all  cases,  however,  it  is  more  or  less  loosened  at  its  borders,  and 
diflers  materially  from  that  of  the  healthy  tissue.  And  while  at 
the  point  of  separation  it  is  covered  with  a  layer  of  granulations, 
highly  vascular,  yet  the  continuity  of  the  fibres  between  the 
healthy  and  the  diseased  tissues  still  exists  in  the  parts  which  are 


DISEASES    OF    THE    WITHERS.  773 

deeper  and  more  central,  where  the  connection  is  maintained  by  a 
sort  of  peduncle  of  varying  size,  through  which  the  necrosis  con- 
tinues to  be  propagated.  If  the  disease  is  of  sufficiently  long 
standing  the  necrosis  may  involve  the  entire  thickness  of  the  carti- 
lage. In  this  case  the  spongy  tissue  of  the  vertebrae  is  exposed, 
covered  with  the  healthy  granulations,  which  contribute  to  the  cic- 
atrization. This,  however,  is  a  rare  termination,  the  bone,  ordi- 
narily, becoming  necrosed  or  carious,  the  necrosis  being  indicated 
by  its  brownish  color,  its  dryness,  its  roughness  and  its  sonority 
on  percussion,  while  the  caries  is  recognized  by  its  friability,  its 
red  and  yellowish  color,  the  foetid  suppuration  which  oozes  from 
its  areola  and  the  facility  with  which  it  yields  to  the  edge  of  a 
sharp  cutting  instrument. 

This  condition  of  mortification  may  affect  but  a  single  verte- 
bra, but  it  is  not  uncommon  to  find  several,  or  possibly  aU,  the 
spinous  processes  of  the  region  affected. 

While  the  fistula  may  be  considered  as  the  essential  physical 
symptom  of  this  ailment  there  are  other  symptoms  coexisting. 
There  is  accompanying  it  an  external  swelling,  sometimes  diffuse, 
sometimes  compact,  and  more  or  less  indurated,  according  to  the 
duration  of  its  existence ;  very  painful  on  pressure,  and  of  which 
the  form,  direction  and  extent  so  perfectly  correspond  with  those 
of  the  fistula,  that  it  may  be  viewed  as  accurately  representing 
the  extent  and  limits  of  the  lesion  itself. 

This  induration  increases  in  consistency,  and  may  with  time 
become  infiltrated  with  calcareous  deposits,  or  even  bony  growths, 
attached  to  the  spinous  processes. 

The  diagnostic  and  prognostical  importance  of  this  induration 
is  very  great.  So  long  as  there  is  no  perceptible  decrease  in  its 
dimensions,  no  apparent  improvement  in  the  external  wound  or 
modification  in  the  nature  and  amount  of  the  discharge  can  be  of 
any  favorable  signification,  and  the  surgeon  may  feel  thoroughly 
assiu'ed  that  the  disease  continues  unchanged  in  extent  and  char- 
acter. As  it  diminishes  it  indicates  that  the  necrosis  is  also  con- 
tracting its  limits,  and  it  becomes  certain  that  the  sloughing  has 
taken  place  and  the  wound  is  once  again  assuming  its  character 
of  original  simplicity.  And  when  the  swelling  disappears,  and 
■  the  tissues  have  resumed  their  normal  integrity,  questions  as  to 
the  depth  of  the  fistula,  or  the  extent  of  its  sinuosities,  and  abun- 
dance of  the  discharge  will  cease  to  be  of  any  significance. 


774  DISEASES    OF    THE    WITHEKS. 

In  the  beginning  of  tlie  necrosis,  while  the  parts  are  verj 
sensitive,  the  exaggerated  sensibility  is  not  at  all  in  proportion  to 
the  apparent  extent  of  the  disease.  The  animal  shrinks  from  the 
manii^ulations  of  the  touch,  and  this  is  a  symptom  which  should 
be  carefully  considered  in  its  relation  to  the  progress  of  the  dis- 
ease, from  the  fact  that  in  these  manifestations  it  is  passing 
through  the  same  phases  as  those  which  marked  the  progress 
of  the  induration,  running  a  sort  of  parallel  with  the  duration 
of  the  necrosis,  and  diminishing  as  the  sloughing  proceeds,  the 
interior  situation  being  interpreted  by  the  exterior  phenomena, 
with  some  exceiDtions.  For  there  are  cases  in  which  it  diminishes, 
while  the  disease  continues  without  change,  to  exhibit  the  same 
severe  sj-mptoms.  One  effect  of  the  abundant  suppuration  accom- 
panying diseased  withers,  and  the  febrile  symptoms  which  accom- 
pany it,  is  a  rapid  loss  of  flesh  by  the  suffering  animal. 

The  disease  is  always  of  long  duration,  and  even  when  treated 
in  the  most  rational  manner.  Its  persistency  will  naturally  cor- 
respond with  the  slow  process  of  the  sloughs  and  repairs  of  the 
tissues  involved,  themselves  of  comparatively  low  vitality  and 
slow  of  change.  But  as  soon  as  the  separation  of  the  diseased 
parts  has  taken  place,  however  deejD  the  wound  may  have  been, 
or  whatever  the  number  and  depth  of  the  fistulae,  the  cicatriza- 
tion proceeds  rapidly,  and  is  comjileted  in  a  comparatively  short 
time.  The  terminations,  which  are  to  be  looked  for,  are  classified 
by  Bouley  and  Nocard  under  the  following  heads : 

1st.  Resolution.  —  This  is  very  rare  if  the  disease  has  been 
neglected,  and  only  occurs  when  it  has  been  of  a  circumscribed 
extent  and  seated  in  a  region  favorably  situated  for  the  elimin- 
ation of  the  mortified  tissue,  as  when  it  escaj^es  through  large 
oj^enings,  without  lying  long  enough  in  the  midst  of  the  muscular 
substance  to  produce  the  effects  of  the  long  confinement  of  the 
pus  in  the  deeply  situated  regions. 

2d.  Disease  of  the  neck,  when  the  necrosis  has  spread  as  far 
forward  as  the  cervical  joortion  of  the  ligamentum  nuchte.  This 
forms  the  more  common  termination,  and  is  as  serious  and  fatal 
as  the  original  disease  itself.  It  is  too  often  met  with,  especially 
in  low-bred  animals  of  lymphatic  constitution. 

3d.  Death,  too  frequently. 

4th.  Putrid  infection,  due  to  purulent  fermentation  and  the 
absorption  of  septic  principles. 


DISEASES    OF    THE    WITHERS.  775 

5th.  Purulent  infection,  i.  e.,  consecutive  with  the  caries  of  the 
Tertebrse  and  with  the  phlebitis  of  the  veins  of  the  region. 

6th.  Purulent  pleurisy,  resulting  from  the  passage  of  the  pus 
into  the  thoracic  cavity  through  the  intercostal  muscles. 

7th.  Exhaustion,  in  consequence  of  the  uncompensated  loss 
of  substance  b}^  the  abundant  continued  suppuration,  and  its  ac- 
companying severe  and  persistent  fever. 

Fistulous  withers  is  always  a  serious  disease,  not  only  because 
of  its  progressive  tendency,  but  also  because,  however  intelligent 
and  proper  may  be  the  treatment  it  receives,  it  can  never  be  relied 
on  to  prevent  the  spreading  of  the  necrosis,  and  assure  a  healthy 
cicatrization.  The  degrees  of  severity  nevertheless  vary,  accord- 
ing to  circumstances.  It  is  less  serious  when  the  necrosis  is  on 
the  median  line,  and  the  prognosis  is  still  more  favorable  when  it 
is  on  the  posterior  part  of  the  region.  "WTien  situated  forward  it 
seems  more  tenacious,  and  the  danger  of  its  extending  to  the 
neck  is  greater.  But  it  is  principally  when  its  seat  is  in  the  an- 
terior part  of  the  withers  that  the  prognosis  becomes  alarming,  as 
there  the  spinous  processes  are  less  prominent,  the  muscles  thick- 
er and  more  complicated  in  their  arrangements,  and  the  cartilage 
of  the  scapula  nearer,  all  these  being  conditions  which  render  the 
discharge  of  the  pus  more  difficult  and  the  purulent  infiltrations 
more  likely  to  take  place,  and  where  also  counter-openings  are 
made  with  more  difficulty,  and  indeed  become  almost  impossible 
if  the  purulent  accumulations  are  situated  on  the  inside  of  the 
scapula  or  its  cartilage  of  prolongation. 

It  may  be  said,  in  fact,  that  the  most  important  factor  in  the 
prognosis  of  this  disease  is  the  distance  which  separates  the  apex 
of  the  spinous  processes  of  the  vertebrae  from  the  superior  border 
of  the  cartilage  of  the  scapula ;  the  chances  of  recovery  being  in 
the  ratio  of  the  distance  between  those  two  points.  It  is  thus 
that  it  becomes  less  grave  in  well-bred  animals,  with  elevated  pro- 
jecting withers,  than  in  low  draught  horses  in  which  that  region 
is  depressed  and  thick,  and  the  projection  of  the  dorsal  processes 
often  replaced  by  a  deep  groove,  bound  on  each  side  by  the  pro- 
jection of  the  muscles  and  of  the  border  of  the  scapular  cartilage. 
The  disease  is  also  of  less  gravity  in  young  animals,  except  when 
they  are  under  the  influence  of  distemper. 

The  treatment  required  in  fistulous  withers  includes  two  prin- 
cipal indications :  1st.  To  facilitate  the  escape  of  the  pus  and 


776  DISEASES    OF    THE    WITHERS. 

obviate  its  action  upon  tlie  tissues  with  which  it  comes  in  contact 
and  prevent  its  necrosing  influence,  and  second  to  accelerate  the 
ehmination  of  the  necrosed  parts. 

The  first  indication  is  fulfilled  in  enlarging  the  fistulas  to  the 
greatest  extent  possible.  This  is  done  with  the  straight  bistoury 
carried  in  the  groove  of  the  director  or  of  the  S  probe,  introduced 
into  the  tract  as  far  as  possible.  But  when  the  fistula  runs  ob- 
liquely downward  and  inward,  and  has  become  complicated  with 
diverticulums  which  run  into  the  depths  of  the  tissues,  this  en- 
largement of  the  fistula  is  more  difficult,  inasmuch  as  it  necessi- 
tates too  extensive  a  division  of  tissues  for  safety.  This  difficulty 
is  obviated  by  establishing  counter-openings  at  points  correspond- 
ing with  the  bottom  or  cul-de-sac  of  the  fistula. 

The  situation  of  these  counter-openings  must  be  carefully  cal- 
culated in  order  to  make  the  drainage  perfect.  The  instruments 
most  suitable  are  the  dog  seton  needle,  a  curved  trocar,  or  prefer- 
ably the  S  probe,  and  a  straight  bistoury.  The  openings  must 
be  liberal  to  assure  the  best  results,  and  they  must  be  prevented 
from  contracting  or  too  rapidly  closing,  and  so  checking  the  pur- 
ulent flow  either  by  the  introduction  of  a  tent  of  oakum  or  other 
permeable  foreign  substance,  or,  and  it  is  much  the  better  method, 
by  the  use  of  a  drainage  tube  similar  to  the  India  rubber  ii-riga- 
tion  tube.  This  implement,  besides  fulfilling  all  the  other  indica- 
tions desired,  possesses  the  additional  advantage  of  facilitating 
the  injection  of  fluid  detergents  or  curatives  into  the  fistulous 
tract.  When  the  drainage  has  become  well  established  irrigations 
must  be  made  two  or  three  times  daily  as  long  as  may  be  neces- 
sary. The  fluids  best  adapted  as  being  both  detergent  and  cura- 
tive in  their  natui*e  are  pure  tepid  water,  phenicated  water  (five 
per  cent,  solution),  or  permanganate  of  potash  solution  (one  to 
two  per  cent.),  or  again  simple  alcoholic  water.  The  irrigation 
can  be  made  with  an  ordinary  syringe.  Peuch  and  Toussaint, 
however,  say  "  that  when  the  circumstances  allow  it  cold  water  in 
continued  irrigation  constitutes  the  best  medication  and  that 
which  prevents  most  certainly  all  comjDlications.  On  that  account 
they  cannot  recommend  it  too  strongly." 

While  this  form  of  treatment  is  usually  successful  in  cases  of 
lesser  severity,  there  are  many  instances  in  which  they  become 
powerless,  and  other  means  become  necessary  for  the  removal  of 
the  necrosed  part.     In  times  gone  by  caustics,  in  both  the  solid 


DISEASES    OF    THE   WITHERS.  777 

and  liquid  form,  were  held  in  high  repute,  even  in  the  form  of 
actual  cauterization,  as  recommended  by  Lafosse.  In  later  times, 
however,  the  serious  effects  which  followed  their  application  caused 
them  to  be  ignored.  Preparations  of  lesser  severity  were  then 
recommended,  among  which  were  Villate's  solution;  those  of  the 
sulphates  of  copper  or  of  zinc,  in  various  degrees  of  strength; 
of  tincture  of  iodine,  of  spirits  of  turpentine,  of  nitrate  of  silver, 
and  even  of  tartar  emetic,  and  their  use  was  followed  by  good 
results. 

Cantharides  ointment,  apphed  externally  over  the  swelling, 
and  by  injections  into  the  fistulous  tract,  after  being  diluted  with 
tincture  of  cantharides,  is  also  recommended. 

When  the  pus  has  filtrated  inside  of  the  shoulder,  Bouley  and 
Nocard  suggest  the  propriety  of  "attempting  to  lacerate  with  a  me- 
tallic rod  the  cellular  tissue  of  the  internal  face  of  the  shoulder,  so 
as  to  produce  an  abscess  by  congestion,  whose  opening,  which  must 
be  made  wide,  would  allow  the  escape  of  the  pus,  and  the  possible 
frequent  cleansing  of  the  enormous  fistula  thus  formed.  By  this 
process  one  might  avoid  the  serious  accidents  likely  to  result  from 
the  sejourn  of  the  pus,  and  its  fermentation  from  the  contact  of 
the  tissues." 

For  cases  like  these  Lafosse  recommended  the  trephining  of 
the  scapula — a  very  serious  operation.  It  is  said  to  have  been 
successful  with  him,  but  it  must  be  a  difficult  matter  to  perform 
it  properly  in  such  a  manner  that  the  trephine  is  appHed  at  a  point 
on  the  surface  exactly  corresponding  to  the  bottom  of  the  fis- 
tula. 

When  all  means  of  so  stimulating  the  action  of  the  parts  as 
to  effect  the  arrest  of  the  necrosis,  and  the  sloughing  of  the  morti- 
fied structure  have  failed,  there  is  but  one  alternative  left,  and 
that  is  the  direct  amputation  of  the  apex  of  the  spinous  ^jrocess, 
and  the  excision  of  the  diseased  portion  of  the  ligament.  But 
this  operation,  indicated  by  Lafosse,  is  possible  only  w^hen  the 
disease  is  limited  to  the  apex  of  the  most  prominent  spinous  pro- 
cesses. It  is  positively  contra  indicated  in  low  and  thick  withers, 
in  which  the  wound  left  after  the  operatio-n  would  be  a  hollow, 
cup-shaped  depression,  from  which  the  pus  would  naturally  gravi- 
tate and  filtrate  in  all  directions. 

The  instruments  necessary  for  this  operation  are  :  A  grooved 
director,  curved  and  straight  bistouries,  sage-knives,  sharp  draw- 


/  I  b  DISEASES    OF    THE    WITHERS. 

ing  knives,  bull-dog  forceps,  and  an  amputating  saw ;  and  with- 
these  the  apj)liances  usually  needed  in  the  way  of  hemostatics, 
and  the  necessary  dressings,  artery  forceps,  oakum,  sjDonges, 
drainer-tubes,  dog  seton  needles,  etc.  The  various  steps  of  tlie 
operation- are  thus  described  by  Peuch  and  Toussaint : 

"Everything  being  ready,  the  operator  enlarges  the  fistulous 
tract,  simple  or  ramified  as  it  may  be,  so  as  to  expose  the  ne- 
crosis. In  making  this  special  attention  must  be  taken  to  give 
the  incision  a  direction  favorable  to  the  escape  of  the  pus.  This 
first  step  of  the  operation  is  accompanied  with  abundant  hemor- 
rhage, which  must  first  of  all  be  arrested  either  by  ligating  the 
divided  blood  vessels,  or  by  plugging  the  wound  with  oakum 
moistened  with  a  solution  of  perchloride  of  iron.  The  hemor- 
rhage stopped,  and  the  necrosis  exposed,  the  second  step,  and  the 
important  one  of  the  operation,  is  jDroceeded  with.  To  eifect  this 
the  necrosed  surface  is  limited  by  a  double  incision,  made  with  a 
sharp  instrument,  straight  bistoury,  or  sage-knife.  This  incision 
involves  the  entu'e  thickness  of  the  cervical  Ugament  and  the  fibro- 
cartilage  covering  the  apex  of  the  spinous  process  and  passing 
under  this  cartilage.  In  making  this  incision  the  operator  must 
be  careful  not  to  injure  any  of  the  other  processes  if  they  are  not 
diseased.  This  done,  with  the  sage-knife  the  deepest  layers  of 
the  cartilage  are  excised,  and  then,  with  the  drawing  knife,  the 
bony  tissue  underneath  is  resected  so  as  not  to  leave  the  smallest 
particle  of  necrosed  tissue.  Here,  as  in  some  cases  of  foot  opera- 
tion, not  only  must  all  the  diseased  tissue  be  removed,  but  some 
of  the  healthy  structures.  The  resection  of  the  apex  of  the  ne- 
crosed processes  can  be  made  with  the  saw  instead  of  the  draw- 
ing knife.  But  this  instrument  is  preferable,  as  it  is  easier  to 
manipulate  and  it  always  leaves  a  smooth  wound." 

The  subsequent  treatment  is  of  the  routine  kind.  The  parts 
are,  of  course,  thoroughly  cleansed;  the  hemorrhage  is  controlled 
by  pressure,  a  drain  tube  is  secured  at  the  lower  angle  of  the 
wound,  and  the  edges  are  brought  together  by  quilled  sutiu-es. 
Kepeated  injections  of  phenicated  water  are  passed  through  the 
di-ainage  tubes,  and  the  patient  is  watched  in  order  to  prevent  him 
from  injuring  himself  by  rubbing.  If  the  season  and  the  circum- 
stances permit,  continued  irrigation  is  established. 

Toward  the  fourth  or  fifth  day  the  sutures  are  removed  and 
the   dressing   changed.      The    granulating   process   is   carefully 


DISEASES    OF    THE    WITHERS.  779 

watched,  and  its  progress  kept  under  control  by  mild  caustic  ap- 
plications, or  by  pressui-e,  to  prevent  an  uneven  and  too  rapid 
cicatrization 

During  the  treatment  the  animal  must  be  kept  quiet,  and  even 
in  some  cases  it  will  be  prudent  to  hobble  his  fore  legs  in  order  to 
limit  his  movements  and  prevent  the  filtration  of  the  pus  under 
the  shoulder.  He  is  to  be  kept  on  light  and  nutritive  diet,  to 
compensate  for  the  losses  resulting  from  the  abundant  suppura- 
tion, and  when  the  disease  has  disappeared,  and  there  is  only  a 
superficial  wound  remaining,  and  no  more  fear  of  returning  com- 
plications or  relapses,  the  animal  can  be  returned  to  his  labors, 
but  must  make  his  adieus  to  the  bulky  collar  which  has  weighed 
so  heavily  on  his  neck,  and  substitute  for  it  the  equally  efficient 
and  far  more  sightly  Dutch  collar,  which  has  never  yet  in  any  way 
contributed  to  bring  upon  its  wearer  the  calamity  of  diseased 
withers. 

DISEASES  OF  THE  POLL. 

This  region  of  the  neck  is  the  seat  of  lesions,  frequently  occur- 
ring, and  of  varying  nature.  They  include  excoriations,  oedema- 
tous  swellings,  cores,  cysts,  bloody  tumors,  abscesses,  bruises, 
wounds,  etc.,  any  of  which  may  become  complicated,  and  termi- 
nate in  poll  evil,  or  the  necrosis  of  one  of  the  fibrous,  elastic,  or 
bony  elements  which  enter  into  the  composition  of  that  region. 

Li  considering  the  anatomical  structure  of  the  portion  of  the 
neck  in  question  we  find  on  the  to2)  a  mass  of  hair,  separated  from 
that  of  the  superior  border  of  the  neck  by  a  surface  which  has 
become  callous  by  the  constant  frictions  of  the  head-strap  of  the 
halter  or  of  the  bridle;  the  skin  (Fig.  563),  thick  on  the  median 
line,  thinner  on  the  sides,  but  always  loosely  connected  with  the 
subjacent  tissues;  a  thick  layer  of  connectwe  tissue,  more  or  less 
infiltrated  with  fat,  and  lardaceous  in  low-bred  horses ;  the  cord  of 
the  ligamentum  nuchse,  which  is  attached  to  the  occipital  bone, 
and  more  or  less  covered  by  the  cervico-auricularis  muscles ;  on 
each  side,  and  on  the  same  level,  the  terminal  insertion  of  the 
spleniiis  muscles,  and  forming  an  elevation  which  is  covered  by 
the  aponeurosis  common  to  that  muscle  and  the  small  complexus, 
which  itself  makes  an  apparatus  of  retention  of  great  resistance 
to  the  organs  of  the  region ;  then  another  layer,  composed  of  the 
large  tendon  of  the  great  complexus,  the  small  oblique  muscle  of 


780 


DISEASES    OF    THE    POLL. 


Fig.  563— Section  of  the  Neck  on  a  Level  with  the  Poll 
p.— The  skin,  to.— Lardaceous  connective  tissue  on  the  top  of  cervical  ligament, 
gc— Superior  extremity  of  the  great  complexus  and  small  oblique  muscle  of  the  head. 
Ic— Ligament  nuchee.  dp.— Posterior  straight  muscles  of  the  head,  lao.— Atloido- 
occipital  ligament.  Is.— Superior  part  of  the  atlas.  sm.— Rachidian  dura  mater. 
m.— Spinal  marrow,  ta.— Adipose  tissue  of  the  rachidian  canal,  a. — Atlas,  ph. — 
Pharynx,  go.— Section  of  the  great  oblique  muscle  of  the  head,  ao.— Section  of  odon- 
toid process  of  the  axis,  p.— Parotid  gland,  sm.— Sub-maxillary  gland,  da.— Anterior 
straight  of  the  head,    ce.— (Esophagus. 

the  head,  the  great  oblique^  and  under  them,  the  posterior  straight 
muscles  of  the  head;  a  serous  sac,  assisting  the  ghding  of  the 
cord  of  the  Hgamentum  nuchse  over  the  atlas,  which  is  very  small 
in  young  animals,  assumes  larges  dimensions  in  old  subjects ;  and, 
finally,  a  skeleton  of  the  region,  the  atlas,  the  axis  and  the  occi- 
pito-atloid  and  atloido-axoid  articulations.  Two  large  arteries  are 
distributed  throughout  the  locality,  the  occipito-muscular  and  the 
atloido-muscular. 

The  causes  in  which  diseases  of  the  poll  originate  are  numer- 
ous. Among  them  may  be  mentioned  first,  bruises,  from  blows 
given  with  the  handle  of  a  whij),  or  of  a  fork;  contusions  and 
continued  frictions  against  hard  substances,  as  the  manger;  the 
pressure  and  rubbing  of  the  parts  of  the  harness  (the  bridle,  etc.), 
which  pass  over  that  region;  the  repeated  rubbing  which  the  ani- 
mal inflicts  upon  himself  when  he  is  afi'ected  with  parasitic  cuta- 
neous disease;  the  blows  which  he  receives  when  in  tossing  his 
head,  he  brings  it  in  contact  with  the  ceiling  of  his  stable,  when 
this  is  too  low,  and  he  has  formed  the  habit  of  pulling  back  on 
the  halter ;  the  spreading  of  diseases  of  the  neck  by  the  extension 
of  the  necrosis  of  the  cord  of  the  cervical  ligament,  all  these  are 


DISEASES    OF    THE    POLL.  781 

considered  to  be  so  many  active  agencies  in  the  etiology  of  poll 
evil. 

In  cattle  it  is  most  commonly  chargeable  to  the  pressure  and 
frictions  of  the  yoke.  Hertwig,  with  other  German  authors,  con- 
siders it,  and  particularly  the  sus-atloid  hygroma,  as  the  local  mani- 
festation of  a  diathesic  condition,  such  as  rheumatism  and  dis- 
temper. They  also  admit  that  the  true  poll  evil  may  develop  itself 
spontaneously,  and  independently  of  all  other  traumatic  causes. 

In  considering  the  various  forms  which  the  disease  may  assume 
in  this  locality  we  shall  adopt  the  division  sanctioned  by  Bouley, 
who  has  thus  arranged  them. 

A — ExcoKiATioNS ;  B — (Edematous  Swellings;  C — Cobe; 
D — Bloody  Tumors. 

Diseases  of  the  poD,  in  horses,  exhibit  too  close  a  resemblance 
in  their  type  and  general  history  to  escape  notice,  and  the  ther- 
apeutic indications  exhibited  in  them  are  the  same.  And  it  must 
be  borne  in  mind  that  however  slight  they  may  ajDpear  to  be,  and 
whatever  may  be  their  nature,  they  always  require  immediate  at- 
tention and  careful  watching,  and  in  all  cases  the  use  of  the  bridle 
and  the  halter  must  be  suspended. 

E.— Cyst. 

Cysts  of  the  poll  are  divided  into  superficial  and  deej).  The 
former,  which  are  of  uncommon  occurrence,  have  their  seat  in  the 
subcutaneous  cellular  tissue,  and  possess  features  in  common  with 
those  which  appear  at  the  withers.  The  latter  is  an  abnormal 
dilatation  of  the  serous  sac  which  facHitates  the  gliding  of  the 
cervical  cord  upon  the  atlas ;  it  is  also  known  as  the  atloid  hy- 
groma. It  generally  begins  suddenly,  and  is  manifested  by  the 
presence  of  a  soft  tumor,  fluctuating,  spherical,  or  bilobulated  by 
the  median  pressure  of  the  cervical  ligament.  It  is  usually  pain- 
less, except  when  it  is  the  result  of  acute  \iolence,  in  which  case 
it  may  be  accompanied  with  inflammatory  symptoms,  which  may 
extend  to  suppuration,  but  in  such  cases,  which,  however,  are  in- 
frequent, there  is  also  a  degree  of  fever  corresponding  in  intensity 
with  the  other  features  of  the  case.  The  fluctuation  is  at  first 
imiform,  and  easily  detected,  but  at  a  later  period,  as  the  secre- 
tion becomes  more  abundant,  and  the  tension  of  the  pouch  be- 


782  DISEASES   OF    THE   POLL, 

comes  greater,  and  the  thickening  of  the  walls  progresses,  it  be- 
comes obscure. 

In  the  stable  the  animal  is  very  quiet,  standing  with  the  neck 
extended  and  the  head  carried  downward ;  he  moves  with  difficulty, 
without  raising  the  head,  and  avoiding  all  movements  of  the 
muscles  of  the  neck,  and  especially  of  the  extensors.  At  times 
the  distension  of  the  walls  of  the  cyst  may  be  so  extreme  that 
the  capsular  ligament  of  the  occipito-atloid  joint  is  pushed  in- 
ward in  the  rachidian  canal,  and  when  this  occurs  nervous  symp- 
toms appear,  caused  by  the  pressure  of  the  rachidian  bulbs. 

If  unremedied,  it  assumes  a  chronic  condition,  with  progres- 
sive distension,  which  may  end  in  death  by  pressure  upon  the 
bulb.  Purulent  transformation,  and  poll  evil  proper,  are  also  the 
possible  terminations  of  the  atloid  hygroma;  indeed,  it  is  only  in 
rare  instances  that  it  is  known  to  subside  by  resolution  or  resorp- 
tion. In  cases  of  doubtful  diagnosis  as  to  the  formation  of  cystic 
or  purulent  collections,  exploration  will  relieve  the  doubt,  and  at 
once  settle  the  question  of  treatment. 

Blistering  and  absorbing  applications,  often  repeated,  and 
combined  with  aspiration,  have  often  relieved  the  atloid  hygroma. 
Cauterization  in  lines  or  points,  both  suj^erficial  and  deep,  are 
also  recommended.  Injections  of  tincture  of  iodine  have  also 
their  supporters,  but  they  are  sometimes  liable  to  give  rise  to  vio- 
lent irritation,  ending  in  purulent  collections,  and  perhaps  necrosis 
possibly  of  the  cervical  ligament. 

F. — Abscess. 

This  is  the  most  frequent  lesion  of  the  poll,  forming  at  once, 
when  the  exciting  cause  is  sufficiently  active,  or  when  originating 
in  the  manner  already  described. 

It  consists  at  first,  of  a  diffused,  not  weU  defined,  swelling  of 
the  abundant  cellular  tissue  which  sej)arates  the  muscles  of  the 
region,  to  coalesce  at  a  later  period,  to  form  a  single  purulent 
gathering,  but  not  until  it  has  macerated  and  destroyed  all  the 
intermediate  tissues  into  which  it  had  become  infiltrated,  and  this 
destructive  process  advances  so  actively  and  persistently  that  when 
it  reaches  the  surface,  instead  of  closing  up,  the  abscess  has  be- 
come transformed  into  a  fistulous  center,  with  a  constant  dis- 
charge of  mortified,  fibrous,  elastic,  or  bony  structure. 


DISEASES    OF    THE    POLL.  783 

The  establishment  of  the  svippurative  process,  even  before 
any  local  symptoms  have  been  manifested,  is  betrayed  by  the 
changed  appearance  of  the  animal.  As  described  in  the  previous 
pages,  he  becomes  listless  and  dull,  standing  quietly  with  the 
neck  extended  and  the  head  resting  on  the  manger;  refusing  to 
move,  or  if  doing  so,  never  raising  his  head,  and  by  grunts  and 
moans  betraying  the  great  pain  he  is  suffering.  If  his  head  be 
raised  by  force  he  rebels  against  it,  struggles,  goes  backward, 
strikes  with  his  fore  feet,  and  perhaps  rears. 

By  bringing  the  animal  under  control  and  restraint,  as  by 
throwing  him,  the  abscess  may  be  easily  discovered,  on  one  side 
of  the  neck,  as  a  diffused  swelling,  tense,  warm,  and  so  excessively 
sensitive  to  the  sHghtest  contact,  that  it  is  with  the  greatest  diffi- 
culty that  an  obscure  and  deej)  fluctuation  can  be  detected.  The 
positive  nature  of  this  tumor  must  then  be  made  out  as  early  as 
possible,  by  repeated  capillary  explorations,  since  if  discovered  to 
be  unmistakably  of  a  suppurative  nature,  a  free  exit  to  the  pus 
must  be  at  once  established,  to  avoid  its  necrotic  tendency ;  while 
if  it  be  a  cyst,  there  is  danger  in  opening  it,  arising  from  its  lia- 
bility to  be  followed  by  necrosis  of  the  cer\ical  ligament. 

The  prognosis  of  this  abscess  will  vary  according  to  the 
length  of  time  which  may  have  elapsed  between  its  incej^tion  and 
its  detection.  The  serious  nature  of  this  prognosis  is  explained 
by  the  fact  of  tho  incomjjressibility  of  the  pus  and  the  inextensi- 
biUty  of  the  aponeurosis  of  the  splenius  and  complexus  muscles, 
which  resist  the  swelling  of  the  inflamed  tissues,  and  by  their 
compression  and  strangulation,  become  the  cause  of  gangrene.  If 
a  diagnosis  of  abscess  is  made,  and  it  is  immediately  opened,  the 
cavity  may  assume  the  character  of  an  ordinary  abscess,  and  close 
entirely ;  but  this  is  a  rare  termination.  More  ordinarily,  the  incar- 
ceration of  the  infiltrated  pus  between  the  muscular  layers  is  an 
obstacle  to  its  free  and  complete  discharge,  and  it  remains  infil- 
trated, gathering  into  cul-de-sacs,  and  migrating  irregularly  be- 
tween the  muscles.  Hence  the  formation  of  so  many  fistulous 
tracts,  opening  at  diverse  points  on  the  skin,  which  are  generally 
the  result  of  the  necrosis  of  the  ligamentum  nuchse,  or  of  the 
fibrous  tissue  of  the  tendons,  or  even  of  that  of  the  atlas,  or 
possibly  of  the  occipital  bone. 

All  the  dangers  which  are  likely  to  follow  the  existence  of  an 
abscess  at  the  poll,  demonstrate  the  necessity  for  prompt  surgi- 


784  DISEASES    OF    THE    POLL. 

cal  interference.  Whenever  the  presence  of  the  pus  is  established 
the  abscess  must  be  opened,  and  opened  very  freely.  This  must 
be  cai'efully  done.  The  puncture  must  be  made  in  the  center  of 
the  tumor,  and  after  the  evacuation  of  the  pus  it  njust  be  ex- 
tended with  the  bistotu-y,  introduced  with  the  aid  of  a  grooved 
director,  and  making,  of  course,  a  counter-opening  at  the  most 
dependent  point.  This  incision  should  be  made  parallel  with  the 
cervical  ligament,  and  must  be  carefully  made,  in  order  to  avoid 
wounding  the  capsular  ligament  of  the  joint,  or  the  occipito-mus- 
cular  artery. 

The  hemorrhage  which  accompanies  this  operation  is  easily 
controlled  by  pressure.  Antiseptic  dressings,  with  the  use  of  a 
drainage  tube  constitute  the  after-treatment,  which  must  be  simUar 
to  that  of  the  same  diseases  at  the  neck  and  at  the  withers,  with 
the  difference,  perhajas,  that  the  dressings  and  cleanings  must  be 
oftener  renewed. 

If  no  complications  arise  the  wound  will  heal  without  diffi- 
culty, and  the  animal  may  be  able  to  resume  work  after  two  or 
three  weeks'  recuperation. 

Poll   Evil. 

But  if,  on  the  contrary,  the  animal  is  suffering  with  the  per- 
sistent and  tenacious  lesion  which  consists  in  the  necrosis  of  the 
yellow  or  white  fibrous  tissue  of  the  region,  or  a  diseased  condi- 
tion of  the  surrounding  bones,  we  are  confronted  with  the  very 
serious  affection  commonly  known  as  poll  evil. 

This  disease  originates,  ordinaiily,  in  one  of  those  already  con- 
sidered, and  yet  it  may  appear  sj)ontaneously,  if  the  instigating 
traumatism  from  which  it  grew  has  been  sufficiently  severe  or 
violent.  And,  again,  it  may  be  a  sequelae  or  extension  of  a  similar 
diseased  process  in  the  neck. 

Its  characteristic  appearance  is  that  of  a  large  induration,  de- 
veloped around  one  or  several  fistulous  tracts,  from  which  escapes 
a  thin,  sanious  pus,  of  foetid  odor.  Upon  being  explored  these 
fistulas  are  found  to  vary  in  their  direction,  in  their  depth,  and  in 
the  tissue  on  which  they  tenninate.  Exploring  with  the  probe, 
or,  more  certain,  with  the  finger,  a  cavity  is  found  more  or  less 
filled  with  pus,  with  granulating  walls,  in  the  bottom  of  which 
the  cervical  ligament  is  felt,  isolated,  roughened  and  more  or  less 
escharrified,  or,  if  this  chord  has  remained  intact,  it  will  indicate 


DISEASES    t)F    THE    POLL.  785 

that  the  seat  of  the  lesions  is  the  tendon  common  of  the  splenius, 
or  of  the  complexu's,  or,  perhaps,  of  the  oblique  or  j)Osterior 
straight  muscles. 

At  an  advanced  period,  when  the  progress  of  the  mortification 
has  been  for  some  time  unchecked,  and  the  bony  insertions  of  the 
ligament,  or  of  the  tendons,  have  become  affected,  the  surfaces  of 
these  bones  also  become  affected  and  their  roughened  or  possibly 
necrotic  character  is  readily  recognized  by  the  exploring  finger. 

It  may  also  hai:)pGn  that  the  capsular  ligament  of  the  joint, 
constantly  macerated  in  the  pus,  softens  and  yields,  and  the  pene- 
tration of  the  discharge  into  the  vertebral  canal  soon  ends  the 
ease  by  the  rapid  development  of  suppurative  cerebro-spinal  men- 
ingitis. 

Hertwig  and  Lafosse  have  reported  instances  where  anchylosis 
of  the  occipito-atloid  joint  had  taken  place. 

There  is  in  the  museum  of  the  American  Veterinary  College  a 
preparation  of  an  anchylosis  of  the  occipito-atloid  articulation 
which  undoubtedly  is  the  result  of  a  case  of  chronic  poll  evil. 

The  prognosis  of  this  ailment  is  always  serious.  A  slight 
lesion  may  grow  and  develop  into  a  case,  with  all  its  dangers. 
For  this  reason  a  cautious  expression  of  opinion  on  the  part  of 
the  surgeon  is  equally  due  to  considerations  of  policy  as  to  the 
obhgations  of  truth. 

The  treatment  is  essentially  and  exclusively  surgical. 

In  the  simplest  cases  free  oj)enings  and  ample  drainage  of  the 
wound,  with  plenty  of  washing  and  antiseptic  attention  will  con- 
trol the  trouble. 

In  more  severe  cases,  where  the  presence  of  the  fistulous 
tracts  is  stimulated  by  the  induration  of  the  parts,  and  the  con- 
stant movements  of  their  walls,  the  external  application  of  a 
strong  blister  and  the  injection  into  the  fistulse  of  tincture  of 
iodine,  or  of  cantharides,  or  of  solutions,  more  or  less  concen- 
trated, of  tartar  emetic,  nitrate  of  silver,  chloride  of  zinc,  etc., 
will  contribute  to  immobilize  the  parts  and  stimulate  the  granu- 
lating and  healing  process. 

The  section  of  the  cord  of  the  ligamentum  nuchae  is  indicated 
when  the  tension  of  the  region  becomes  too  rigid,  and  the  pain  inor- 
dinate. This  alleviating  measure  was  first  instituted  by  Langen- 
Ijacher  and  Hertwig  in  Germany ;  then  by  Lafosse  and  Rey  in 
France,  and  it  has  always  given  excellent  results.     It  relieves  the 


-Sf; 


DISEASES    OF    THE    POLL. 


pressure  and  the  pain,  obviates  the  danger  of  gangrene,  facilitates 
the  examination  of  the  wound,  and  greatly  aids  the  excision  of 
the  soft,  necrosed  tissues,  and  the  scraping  of  their  bony  attach- 
ments. 

I'he  operation  is  simple.  The  patient  is  thrown,  and  a  straight 
bistoury,  or  in  j^reference,  a  blunt  curved  tenotomy  knife  are  the 
instruments.  With  the  latter,  the  division  of  the  skin  is  avoided. 
The  ligamentous  section  is  subcutaneous,  the  instrument  being 
introduced  under  the  cord,  and  the  division  made  from  within 
outward.  When  the  section  is  made,  the  ends  of  the  ligament 
draw  apart.  If  it  is  necrosed,  the  anterior  stump  is  removed  down 
to  its  insertion  in  the  occipital  bone,  which  may  also  be  scraped. 
The  same  treatment  is  applied  to  the  tendons  of  the  muscles.  In 
fact,  the  opening  is  cleared  from  all  mortified  substances,  and 
treated  as  a  simple  wound. 

After  the  operation,  the  animal  carries  his  head  low  down  and 
vertical,  but  when  the  wound  becomes  cicatrized,  and  continuity 
is  re-established  between  the  stump  of  the  ligament  and  the  cervi- 
cal tuberosity,  the  head  becomes  by  degrees  elevated,  and  is  event- 
ually restored  to  its  normal  position  and  natural  liberty  of  motion. 


SELECT     LiST ^ 

OF 

WILLIAM  R.  JENKINS' 

VETERINARY  BOOKS 

— #   1896  ^— 


(*)  Single  asterisk  designates  Neic  Books. 
(**)  Double  asterisk  designates  Recent  Publications. 


ANDEBSOJ^.  "  Vice  in  the  Horse  "  and  other  papers 
Horses  and  Riding.  By  E  L.  Anderson.  Demy, 
8vo,  cloth ' $2.00 

ANDEBSOJV.    "  How  to  Ride  and  School  a  Horse. " 

With    a  System  of  Horse  Gymnastics.     By   Edward 

L.  Anderson.     Cr.  8vo 1  00 

i**)BA  CH.  "How  to  Judge  a  Horse."  A  concise  treatise 
as  to  its  Qualities  and  Soundness;  Including  Bits  and 
Bitting— Saddles  and  Saddling,  Stable  Drainage,  Driv- 
ing One  Horse,  a  Pair,  Four-in-hand,  or  Tandem,  etc. 
By  Captain  F,  W.  Bach.  12mo,  cloth,  fully  illustrated 
$1  00;  paper 

BANIIAM.  "Tables  of  Veterinary  Posology  and 
Therapeutics,"  with  weights,  measures,  etc.  By 
George  A.  Banham,  F.R.C.V.S.    12mo,  cloth 75 


50 


William  R.  Jenkins^  Veterinary  Books. 


BAUCHER.      'New    Method    of    Horsemanship." 

Including  the  Breaking  and  Training  of  Horses 1  00 


BEEL.    "The  Veterinarians  Call  Book  (Perpetnal)." 

By  Roscoe  R.  Bell,  D  V.S.,  Profsssor  of  Materia 
Medica,  Therapeutics  and  Hygiene  in  the  American 
Veterinary  College,  New  York;  President  of  the  Long 
Island  Veterinary  Society ;  late  U.  S.  Goverment 
Veterinary  Inspector,  etc. 

A  visiting  list,  that  can  be  commenced  at  any  time 
and  used  until  full,  containing  much  useful  informa- 
ation  for  the  student  and  the  busy  practioner.  Among 
contents  are  items  concerning :  Veterinary  Drugs; 
Poisons;  Solubility  of  Drugs ;  Composition  of  Milk, 
Bile,  Blood,  Gastric  Juice,  Urine,  Saliva ;  Respiration; 

D3ntition;  Temperature,  etc.,  etc.  Bound  in  leather    1  25 

CLEMENT.  "Veterinary  Post  Mortem  Examin- 
ations."  By  A.  W,  Clement,  V.S.  Records  of 
autopsies,  to  be  of  any  value,  should  accurately 
represent  the  appearances  of  the  tissues  and  organs 
so  that  a  diagnosis  might  be  made  by  the  reader  were 
not  the  examiners  conclusions  stated.  To  make  the 
pathological  conditions  clear  to  the  reader,  some 
definite  system  of  dissection  is  necessary.  The 
absence  in  the  English  language,  of  any  guide  in 
making  autopsies  upon  the  lower  animals,  induced 
Dr.  Clement  to  write  this  bcok,  trusting  that  it 
would  prove  of  practical  value  to  the  profession. 
12mo,  cloth,  illustrated 75 

{**jCADIOT.  "Roaring  in  Horses."  Its  Pathology 
and  Treatment.  This  work  represents  the  latest 
development  in  operative  methods  for  the  alleviation 
of  roaring.  Each  step  is  most  clearly  defined  b/ 
excellent  full-page  illustrations.  By  P.  J.  Cadiot. 
Professor  at  the  Veterinary  School,  Alfort.  Trans. 
Thos.  J.  Watt  Dollar,  M.R.C.V.S.,  etc.     Cloth 75 


William  R.  Jenkins'  Veterinary  Books. 


CHAUVEAU.  "The  Comparative  Anatomy  of  the 
Domesticated  Animals."  By  A.  Chauveau.  New 
edition,  ti-ausiated,  enlarged  and  entirely  revised  by 
George  Fleming,  F.E.C.V.S.  8vo.  cloth  with  5«5 
Illustrations    ..•' 


7  00 


CLARKE.  "H)rses'  Teeth."  A  Treatise  on  their 
Anatomy,  Pathology,  Dejitistry,  etc.  Revised  and 
enlarged.     By  W,  H.  Clarke.  12mo,  cloth 2  50 

CLARKE.      "Chart    of    the    Feet    and    Teeth    ol 

Fossil  Horses.' ^^ 

CLEAVELAND.     "  Proiioiincinsr  Medical  Lexicon. 


Pocket  edition.     Cloth. 


75 


COURTNEY.  'Manual  of  Veterinary  Medicine  and 
Surgery."  By  Edward  Courtney,  V.  S.  Crown,  8vo, 
cloth..*. " 2  75 

{**)COX.    "Horses:   In  Accident  and  Disease."    The 

sketches  introduced  embrace  various  attitudes  which 
have  been  observed,  such  as  in  choking  ;  the  disorders 
and  accidents  occurring  to  the  stomach  and  intestines  ; 
affection  of  the  brain  ;  and  some  special  forms  of  lame- 
ness, etc.  By  J.  Eoalfe  Cox,  F.'lC.V.S.  8vo,  cloth, 
fully  illustrated ^  ^^ 

CURTIS.    "Horses,  Cattle,  Sheep  and  Sivine."    The 

origin,  history  Improvement,  description,  characteris- 
tics, merits,  objections,  etc.  By  Geo.  W.  Curtis, 
M.S.A.  Superbly  illustrated.  Cloth,  S2  00 ;  half 
sheep,  $2.75  ;  half  morocco ^  ^^ 

DALZIEL.  "  British  Dogs."  Describing  the  History 
Characteristics,  Points,  and  Club  Standards,  etc.,  etc. 
With  numerous  colored  plates  and  wood  engravings. 
By  Hugh  Dalziel.     Vol.  I.,  $4  00.     Vol.  II.,  8vo 4  tO 


DALZLEL.     "The  Fox  Terrier."    Illustrated.   (Mono- 
graphs on  British  Dogs) 

DALZIEL.     ' '  The  St.  Bernard. "    Illustrated 1  00 


William  B.  Jenkins'  Veterinary  Books. 


DALZIEL,  '  'The  Diseases  of  Dogs."  Their  Pathology, 
Diagnosis  and  Treatment,  with  a  dictionary  of  Canine 
Materia-Mediea.  By  Hugh  Dalziel  12mo,  paper, 
60c. :  cloth 80 

DALZIEL.    "  Diseases  of  Horses."    12mo,  cloth 1  00 

DALZIEL.  "  Breaking- and  Training- Dogs."  Being 
concise  directions  for  the  proper  education  of  dogs, 
both  for  the  field  and  for  companions.  Second  edi- 
tion, revised  and  enlarged.  Part  I,  by  Pathfinder; 
Part  II,  by  Hugh  Da  ziel.     l-2mo,  cloth,  illustrated. . .     2  60 

DALZIEL.  "  Stud  Books."  Pedigree  of  Prize  Win- 
ners.    8vo,  cloth 1  00 

DALZIEL.  "  The  Collie."  Its  History,  Points,  and 
Breeding.  By  Hugh  Dalziel.  Illustrated,  Svo,  paper, 
50c.,  cloth 1  00 

DALZIEL,    "Tlie  Greyhound."    8vo,  cloth,  illustrated    1  00 

DANCE.  "  Veterinary  Tablet."  Folded  in  cloth  case. 
The  tablet  of  A.  A.  Dance  is  a  synopsis  of  the  diseases 
of  horses,  cattle  and  dogs  with  the  causes,  symptoms 
and  cures 75 

DANA.     "Tables  in    Comparative  Physiology."    By 

Prof.  C.  L.Dana,  M.D ." 25 

DAY.     "The  Race-horse  in  Training."    By  Wm.  Day, 

Svo 3  50 

i**)DUN.     "Veterinary  Medicines,  Their  Actions  and 

Uses."     By  Finlay  Dun,  V.S.     New  Kevised    edition 
(almost  entirely  re-written)  Svo,  cloth 3  50 

DWYEB.  ''Seats  and  Saddles."  Bits  and  Bitting, 
Draught  and  Harness  and  the  Prevention  and  Cure  of 
Kestiveness  in  Horses.  By  Francis  Dwyer.  Illus- 
trated.    1  vol.,  12mo,  cloth,  gilt 150 

FLEMING.    '  'A  Treatise  on  Practical  Horseshoeing." 

By  George  Fleming,  M.R.C.  V.S.     Cloth 75 


William  R.  Jenkins''  Veterinary  Books.  5 

{')FLEMING.  "Veterinary  Obstetrics."  Including  the 
Accidents  and  Diseases  incident  to  Pregnancy,  Parturi- 
tion, and  tlie  early  Age  in  Domesticated  Animals. 
By  Geo.  Fleming.  F.R.C.V.S.     Witli  212  illustrations. 

773  pages,8vo,  cloth  (old  edition) 3  50 

New  edition  revised,  226  illustrations,  758  pages 6  25 

FLEMING.  "Rabies  and  Hydrophobia."  History. 
Natural  Causes,  Symptoms  and  Prevention.  By  Geo. 
Fleming,  M.  E.G. V.S.     8vo,  cloth 3  75 

FLEMING.  "Proi)ag:ation  of  Tnberculosis."  Stating 
Injurious  Effects  from  the  consumption  of  the  Flesh 
and  Milk  of  Tuberculous  Animals.  By  Geo.  Fleming, 
M.D.,  M.R.C.V.S  ,  and  others.     8vo,  cloth 1  50 

FLEMING.     "Tubercnlosis."    From  a  Sanitary   and 

Pathological  Point  of  View 25 

FLEMING.     "  Tlie  Contagions  Diseases  of  Animals." 

Their  influence  on  the  wealth  and  health  of  nations. 
12mo,  paper ; 25 

FLEMING.  "Operative  Veterinary  Snrgery."  Part 
I,  by  Dr.  Geo.  Fleming,  M.R.C.V.S.  This  valuable 
work,  the  most  practical  treatise  yet  issued  on  the 
subject  in  the  English  language,  is  devoted  to  the 
common  operations  of  Veterinary  Surgery;  and  the 
concise  descriptions  and  directions  of  the  text  are 
illustrated  with  numerous  wood  engravings.  8vo,  cloth    2  75 

Orders  are  iio^v  received  for  the  second  voliiiiie,  >vhicli 
is  expected  very  soon. 

FLEMING,     "  Hnman    and    Animal     Variolop."     A 

Study  in  Comparative  Pathology.     Paper 25 

FIjEMING.  "Animal  Plagnes."  Their  History, 
Nature,  and  Prevention.  By  George  Fleming,  F.R.C. 
V.S.,  etc.  First  Series.  8vo,  cloth,  JG.OO ;  Second 
Series.     Bvo,  cloth 3  00 

FLEMING.  "Roaring  in  Horses."  By  Dr.  George 
Fleming,  F.R  C.V.S.  A  treatise  on  this  peculiar  dis- 
order of  the  Horse,  indicating  its  method  of  treat- 
ment and  curability.     8vo,  cloth,  with  colored  plates.     1  50 


William  R.  Jenkins'  Veterinary  Books. 


(*  )E LEMING-NEUMANX.  "Parasites  and  Para- 
sitic  Diseases   of  tlic  Domesticated  Auimals."     A 

work  which  the  students  of  human  or  veterinary  medi- 
cine, the  sanitarian,  agriculturist  or  breeder  or  rearer 
of  animals,  may  refer  for  full  information  regarding 
the  external  and  internal  Parasites— vegetable  and 
animal — which  attack  various  species  of  Domestic 
Animals.  A  Treatise  by  L.  G.  Neumann,  Professor 
at  the  National  Veterinary  School  of  Toulouse. 
Translated  and  edited  by  George  Fleming,  C.  B.,  L.L. 
D.,  F.K.C.V.S.     873  pages,  365  illustrations,  cloth.. . .     7  50 

(**) FRIEDB ERGEJR-  FM OHNEB.  ' '  Pathology 
and  Therapeutics  of  the  Domesticated  Animals." 

By  Dr.  Friedberger.  Translated  by  Prof.  W.  L.  Zuill, 
M.D.,  D.V.S.     2vol 12  00 

GUESS  WELL.  ' '  The  Diseases  and  Disorders  of  the 
Ox."  By  George  Gresswell,  B.A.  With  Notes  by 
James  B.  Gresswell.    Crown,  8vo,  cloth,  illustrated..     3  50 

GRESSWELL.  "Diseases  and  Disorders  of  the 
Horse."  By  Albert,  James  B.,  and  George  Gresswell. 
Crown,  8vo,  illustrated,  cloth 1  75 

ORESS  WELL.  Manual  of  "The  Theory  and  Practice 
of  Equine  Medicine."  By  J.  B.  Gresswell,  F.R.C.V.S., 

and  Albert  Gresswell,  M.R.C.V.S.,  second  edition, 
enlarged,  8vo,  cloth 2  75 

GRESSWELL.      "Veterinary    Pharmacology    and 

Tlierapeutics."  By  James  B.  Gresswell,  F.R.C.V.S. 
16mo,  cloth 1  50 

GRESSWELL.    "The  Bovine  Prescriber."     For  the 

use  of  Veterinarians  and  Veterinary  Students.  By 
James  B.  and  Albert  Gresswell,  M.R.C.V.S    Cloth.  . .        75 

GRESSWELL.     "The  Eqnne  Hospital  Prescriber." 

drawn  up  for  the  use  of  Veterinary  Practitioners  and 
Students.  By  Drs.  James  B.  and  Albert  Gresswell, 
M.R.C.V.S.     Cloth 75 


William  R.  Jenkins'  Veterinary  Books.  7 

GRESSWELL.  "VetermaryPharmacopaeia,  Materia 

Medica  and  Therapeutics."  By  George  and  Charles 
Gresswell,  witli  deseriptions  and  physiological  actions 
of  medicines.  By  Albert  Gresswell.  Crown,  8vo,  cloth.    2  75 

I  **) G  O TTHEIL.     "A  Manual  of  (General  Histolos  j . " 

By  Wm.  S.  Gottheil,  M.D.,  Profe  sor  of  Pathology  in 
the  American  Veterinary  College,  New  York;  etc.,  etc. 
Histology  is  the  basis  of  the  physician's  art,  as 
Anatomy  is  the  foundation  of  the  surgeon's  science. 
Only  by  knowing  the  processes  of  life  can  we  under- 
stand the  changes  of  disease  and  the  action  of  remedies ; 
as  the  architect  must  know  his  building  materials,  so 
mu.st  the  practitioner  of  medicine  know  the  intimate 
structure  of  the  bo. ly.  To  present  this  knowledge  in 
an  accessible  and  simple  form  has  been  the  author's 
task.     8vo.,  cloth,  148  pagjs,  fully  illustrated.  1  00 

HAYES.    "  Veterinary  Notes  for  Horse-Owners. "    An 

every  day  Horse  Book,  Illustrated.  By  M.  H.  Hayes. 
12mo,  clotii 5  00 

HAYES,  "Riding-."  On  the  Flat  and  Across  Country. 
A  Guide  to  Practical  Horsemanship.  By  Captain  M. 
H.  Hayes.     Second  edition,  16mo,  cloth 4  25 

H  A  YES.    '  'Illustrated  Horse  Breaking . "    By  Captain 

M.  H.  Hayes.     12mo,  cloth,  illustrated 8  40 

HATES.      "The  Horsewoman."     By  Captain  M.  H. 

Hayes  and  Mrs.  Hayes.     12rao,  cloth,  illustrated 4  25 

HEATLEY.    "The  Horse  Owner's  Safeguard."     A 

handy  Medical  Guide  for  every  Horse  Owner.  12mo, 
cloth' 1  50 

HEATLEY.      "Practical     Veterinary     Remedies.' 

12mo,  cloth 1  00 

{**)HEATLEY.     "The  Stock  Owner's  Safeguard. "    A 

handy  Medical  Treatise  for  every  man  who  owns  an 
oxorcow.  By  George S.  Heatley,  M. B.C. V.S.  12mo, 
cloth 1  25 


William  R.  Jenkins''  Veterinarv  Books. 


HILL.  "  The  Principles  and  Practice  of  Boyine  Med- 
icine and  Surg-ery."  By  J.  Woodroffe  Hill,  F.R.C.  V.S. 
Cloth.     (Temporarily  out  of  print). 

HILL.  "  Tlie  Management  and  Diseases  of  the  Bog." 
Containing  lull  instructions  for  Breeding,  Rearing  and 
Kenneling  Dogs.  Their  Different  Diseases.  How  to 
detect  and  how  to  cure  them.  Their  Medicines,  and 
the  doses  in  which  they  can  be  safely  administered. 
By  J.  Woodroffe  Hill,  F.R.C. V.S.  12mo,  cloth,  extra 
fully  illustrated 2  00 

HINEBA  UCH.     '  Veterinary  Dental  Surgery."    For 

the    use    of  Students,    Practitioners  and    Stockmen. 

12mo,  cloth,  illustrated 2  00 

Sheep • 2  76 

i**)HOAIlE.  "A  Mannal  of  Veterinary  Therapeutics 
and  Pharmacology."  By  E.  WallisHoare,  F.R.C. V.S. 
12ui(),  e.oth,  56o  pages 2  75 

"Deserves  a  good  place  in  the  libraries  of  all  veterina- 
rians. *  *  *  Cannot  help  but  be  of  the  greatest  assist- 
ance to  the  young  veterinarian  and  the  every  day  busy 
practitioner."— ^l/uesvYaji  Veterinary  Eeview. 

H0LC03IBE^  "Laminitis."  A  contribution  to 
Veterinary  Pathology.  By  A.  A.  Holcombe,  V.  S. 
Pamphlet 50 

KOCH,     "biology  of  Tuberculosis."     By  Dr.   R. 

Koch.     Translated  by  T.  Saure.     8vo,  cloth 1  00 

KEATING.  "A  New  Unabridged  Pronouncing 
Dictionary  of  Medicine."  By  John  M.  Keating,  M.D., 
LL.D.,  Henry  Hamilton  and  others.  A  voluminous 
and  exhaustive  hand-book  of  Medical  and  scientific 
terminology  with  Phonetic  Pronunciation,  Accentu- 
ation, Etymology,  etc.  With  an  appendix  containing 
important  tables  of  Bacilli,  Microcci  Leucomaines, 
Ptomaines ;  Drugs  and  Materials  used  in  Antiseptic 
Surgery ;  Poisons  and  their  antidotes :  Weights  and 
Measures ;  Themoraeter  Scales ;  New  Officinal  and 
Unofficinal  Drugs,  etc.,  etc.    8  vo,  818  pages 5  00 


William  R.  Jenkins'  Veterinary  Books. 


9 


LAMBERT.     "The    Oerm   Theory     of    Disease." 

Bearing  upon  the  health  and  welfare  of  man  and  the 
domesticated  animals.  By  James  Lambert,  F.E.C.V.S. 
8v(».  paper 

LA  W.  "  Farmers'  Veterinary  Adviser."  A  Guide  to 
the  Prevention  and  Treatment  of  Disease  in  Domestic 
Animals.  By  Professor  James  Law.lUustrated.  8vo, 
cloth 3^^ 

LIA  UTABD.  "  Animal  Castration."  A  concise  and 
practical  Treatise  on  the  Castration  of  the  Domestic 
Animals.  The  only  work  on  the  subject  in  the  English 
language.  Illustrated  with  forty-four  cuts.  12mo, 
cloth 

LIAUTABD.     "Vade  Mecum  of  Equine  Anatomy." 

By  A.  Liautard,  M.D.V.S.     Dean  of  the  American  Vet- 
erinary College.     l2mo.  cloth 

LIAUTABD.      "Translation    of    Zundel    on    the 

Horse's  Foot."    Cloth 2  00 

LIA  UTABD.  "How  to  TeU  the  Age  of  the  Domestic 
Animal."  By  Dr.  A.  Liautard,  M.D.,  V.S.  Profusely 
illustrated.    12mo,  cloth - 

LIAUTABD.    " On  the  Lameness  of  Horses."    By 

A.  Liautard,  M.D.,V.S ^  50 

i**)LIAUTABD.  "Manual  of  Operative  Veterinary 
Surgery  "  By  A.  Liautard,  M.D.,  V.M.,  Principal 
and  Professor  of  Anatomy,  Surgery,  Sanitary  Medicine 
and  Jurisprudence  in  the  American  Veterinary  College ; 
Chevalier  du  Merite  Agricole  de  France,  Honorary 
Fellow  of  the  Royal  College  of  Veterinary  Surgeons 
(London),  etc.,  etc.      8vo,  cloth,  786  pages  and  nearly 

ti  00 
600  illustrations 

LONG.     "Booli  of  the  Pig."    Its  selection,  Breeding, 

Feeding  and  Management.    Bvo,  cloth *  25 


10  William  R.  Jenkins^  Veterinary  Books. 

{**)LUPTON.     "The  Horse:  Sound  and  Unsound, »» 

with  Law  relating  to  Sales  and  Warranty.  By  J.  Irvine 
Lupton,  F.R.C.V.S.     8vo,  cloth,  illustrated 1  25 

L  UFTON.  "  The  Horse."  As  he  Was,  as  he  Is,  and 
as  he  Ought  to  Be.  By  J.  I.  Lupton,  F.R.C.V.S.  Illus- 
trated.    Crown,  8vo 140 

MAGNEJR.    "Art    of    Taming   and   Educating   the 

Horse."  By  D.  Magner.  Upwards  of  1,000  pages, 
illustrated  with  900  engravings.  8vo,  cloth,  $5  00; 
sheep,  $6  00 ;  full  morocco 7  50 

MAGNER.  "Yeterinary  Diagrams."  (1)  The  Struc- 
ture of  Horses  Feet  (in  colors).  The  Structure  of 
Horses  Feet  (Effects  of  Bad  Treatnaent  of  the  Feet). 

Mounted  and  Varnished . .     2  00 

(2)  The  Shoeing  of  the  Horse.  The  Education  of  the 
Horse.     Mounted  and  Varnished 2  00 

MAYHEW.     "The  niustrated  Horse  Doctor."    An 

accurate  and  detailed  account  of  the  Various  Diseases 
to  which  the  Equine  Race  is  subject ;  together  with  the 
latest  mode  of  Treatment,  and  all  the  Requisite  Pre- 
scriptions written  in  plain  English.  By  E.  Edward 
May  hew,  M.R.C.V.S.  Illustrated.  Entirely  new 
edition,  8vo,  cloth 2  75 

McBBIDE.     "Anatomical  OutUnes  of  the  Horse." 

12mo,  cloth 2  50 

McCOMBIE.    "  Cattle  and  Cattle  Breeders."    Cloth    100 

JH'FADTEAN.  "Anatomy  of  the  Horse."  A  Dis- 
section Guide.  By  J.  M.  M'Fadyean,  M.R.C.V.S. 
This  book  is  intended  for  Veterinary  students,  and 
offers  to  them  in  its  48  full-page  colored  plates  numer- 
ous other  engravings  and  excellent  text,  the  most 
valuable  and  practical  aid  in  the  study  of  Veterinary 
Anatomy,  especially  in  the  dissecting  room.  8vo, 
cloth 5  50 


Williavi  R.  Jenkins'  Veterinary  Books.  11 


M'FADYEAK.      "Comparative    Anatomy    of   the 

Domesticated  Animals."  By  J.  M'Fadyean.  Pro- 
fusely illustrated,  and  to  be  issued  in  two  parts.   Part 

I_Osteologj',  ready.     Paper,  $2  50;  cloth 2  75 

(Part  II.  in  preparation.) 

MILLS,    "How  to  Keep  a  Dog:  in  tlie  City."    By 

Wesley  Mills,  M.D.,  V.S.  It  tells  how  to  choose 
manage,  house,  feed,  'educate  the  pup,  how  to  keep  him 
clean  and  teach  him  cleanliness.     Paper 25 

{*)MOLLER,    ' '  Operative  Veterinary  Snrger j . "     By 

Professor  Dr.  H.  Moller,  Berlin.  Translated  and 
edited  from  the  2d  edition,  enlarged  and  improved, 
by  John    A.  W.  Dollar.  M.R.C.S. 

Prof.  Holler's  Avork  presents  the  most  recent  and 
complete  exposition  of  the  Principles  and  Practice  of 
Veterinary  Surgery,  and  is  the  standard  text-book  on  the 
subject  throughout  Germany. 

Many  subjects  ignored  in  previous  treatises  on 
Veterinary  Surgery  here  receive  full  consideration, 
while  the  better  known  are  presented  under  new  and 
suggestive  aspects. 

As  Prof.  MoUer's  work  represents  not  only  his 
own  opinions  and  practice,  but  those  of  the  best 
Veterinary  Surgeons  of  various  countries,  the  trans- 
lation cannot  fail  to  be  of  signal  service  to  American 
and  British  Veterinarians  and  to  Students  of  Veter- 
inary and  Comparative  Surgery. 
1  vol.,  8vo.   722  pages,  142  illustrations  . .    5  25 

MOBETON.    "  On  Horse-breaking."    i2mo,  cloth..        50 

MOSSELMAJS-LIENA  UX.  "Veterinary  Microbio- 
logy." By  Professors  Mosselman  and  Lienaux,  Nat- 
ional Veterinary  College,  Cureghem,  Belgium.  Trans- 
lated and  edited  by  R.  R.  Dinwiddle,  Professor  of 
Veterinary  Science,  College  of  Agriculture,  Arkansas 
State  University.     12mo,  cloth,  342  pages 2  50 


12  William  R    Jenkins'  Veterinary  Books. 

ONOCARD.  "The  Animal  Tuberculoses,  and  their 
Relation  to  Human  Tuberculosis."  By  Ed.  Nocard, 
Professor  of  the  Alfort  Veterinary  College.  Trans- 
lated by  H.  Scurfield,  M.D.  Ed.,  Ph.  Camb. 

Perhaps  the  chief  interest  to  doctors  of  human 
medicine  in  Professor  Nocard's  book  lies  in  the 
demonstration  of  the  small  part  played  by  heredity, 
and  the  great  part  played  by  contagion  in  the  propa- 
gation of  bovine  tuberculosis.  It  seems  not  unreason- 
able to  suppose  that  the  same  is  the  case  for  human 
tuberculosis,  and  that,  if  the  children  of  tuberculosis 
parents  were  protected  from  infection  by  cohabitation 
or  ingestion,  the  importance  of  heredity  as  a  cause  of 
the  disease,  or  even  of  the  predisposition  to  it,  would 
dwindle  away  into  insignificance.  ]2mo,  cloth,  143 
pages 1  00 

PEGLER.    "The  Book  of  the  Goat."    12mo,  cloth. . .    1  75 

PROCTOR.  "  The  Management  and  Treatment  of 
the  Horse"  in  the  Stable,  Field  and  on  the  Road. 
By  William  Proctor.    8vo 2  40 

PETERS.  "A  Tuberculous  Herd-Test  with  Tuber- 
culin." By  Austin  Peters,  M.  R.  C.  V.  S.,  Chief 
Inspector  of  Cattle  for  the  New  York  State  Board  of 
Health  during  the  winter  of  1892-93.     Pamphlet 25 

REYNOLD.    "Breeding  and  Management  of  Draught 

Horses."    8vo,  cloth 1  40 

ROBERTSON.    "The  Practice  of  Equine  Medicine." 

A  text-book  especially  adapted  for  the  use  of  Veter- 
inary students  and  Veterinarians.  By  W.  Robertson, 
Principal  and  Professor  of  Hippopathology  in  the 
Royal  Veterinary  College,   London.     8vo.  cloth,  806 

i,  revised  edition 6  25 


(**)ROBERGE.  "The  Foot  of  the  Horse,"  or  Lame- 
ness and  all  Diseases  of  the  Feet  traced  to  an  Unbal- 
anced Foot  Bone,  prevented  or  cured  by  balancing  the 
foot.     By  David  Roberge.    8vo,  cloth 5  00 


William 


R.  Jenkins'  Veterinary  Books.  13 


(*) SMITH.    **A   Manual  of  Yeterinary  Physiology." 

By  Veterinary  Captain  F.  Smith,  M.E.O.V.S.     Author 
of  "  A  Manual  of  Veterinary  Hygiene." 

Throughout  this  manual  the  object  has  been  to  con- 
dense the  information  as  much  as  possible.  The 
broad  facts  of  the  sciences  are  stated  so  as  to  render 
them  of  use  to  the  student  and  practitioner.  In  this 
second  edition— rewritten— Ihe  whole  of  the  Nervous 
System  has  been  revised,  a  new  chapter  dealing  with 
the  Development  of  the  Ovum  has  been  added  together 
with  many  additional  facts  and  illustrations.  About 
one  hundred  additional  pages  are  given.  Second 
edition,    revised  and  enlarged,  with  additional  illus- 

3  75 
trations  

{**) SMITH.    "Manual  of  Yeterinary  Hygiene."   2nd 

edition,  revised .     Crown,  8vo,  cloth 3  25 

STOHNMOUTH.     "Manual  of  Scientific  Terms." 

Especially  referring  to  those  in  Botany,  Natural 
History,  Medical  and  Veterinary  Science.  By  Rev, 
James  Stornmouth ^  00 

{**)STItANGEWAY.    'Yeterinary  Anatomy. '    New 

edition,  revised  and  edited  by  I.  Vaughn,  F.L.S., 
M  R  C  V  S.,  with  several  hundred  illustrations.     8vo, 

cloth.; 500 

VETERINARY  DIAGRAMS.     Five  Charts,   on 

stout  paper,  as  follows : 
No.  1.     With    eight    colored    illustrations.      External 

Form  and  Elementary  Anatomy  of  the  Horse 1  25 

No.  2.     "The  Age  of  the  Domestic  Animals."    With 

forty-two  woodcuts ''-• 

No.  3.     "  Unsoundness  and  Defects  of  the  Horse."  With 

fifty  wood  cuts '^^ 

No.  4.     "The  Shoeing  of  the   Horse,Mule,   and    Ox." 

With  fifty-nine  wood-cuts • "^5 


14  William  R.  Jenkins'   Veterinary  Books. 


No.  5.  "The  Elementary  Anatomy,  Points,  and  Butcher 
Joints,  of  the  Ox."  With  seventeen  colored  illus- 
trations       1  25 

These  are  printed  with  explanatory  text.  Price,  per  set 
of  five 4  7) 

WALLEY.    "Hints  on  the  Breeding-  and  Rearing-  of 

Farm  Animals."    12iuo,  cloth  — 80 

WALLET.  "  Four  Bovine  Sconrges."  (Pleuro-Pneu- 
monla,  Foot  and  Mouth  Disease,  Cattle  Plague  and 
Tubercle.)  With  an  Appendix  on  the  Inspection  of 
Live  Animals  and  Meat.     Illustrated,  4to,  cloth 6  40 

WALLEY.     "The   Horse,    Cow   and   Dog."    By  Dr. 

Thomas  Walley.  A  poetical  account  of  the  "  Troubl- 
ous Life  of  the  Horse  "  ;  "  The  Life  of  a  Dairy  Cow," 
and  "  The  Life  of  a  Dog  "  ;  with  an  article  on  Animal 
Characteristics.     12mo,  cloth 80 

WALLEY.    "A  Practical  Guide  to  Meat  Inspection." 

An  important  work,  and  will  be  found  invaluable  to  all 
Health  oflQcers  and  Sanitarians.  By  Thomas  Walley, 
M.R.C.V.S.  8vo,  cloth,  47  colored  illustrations.  New 
and  revised  edition  in  press  

(**)  WILLIAMS.  "Principles  and  Practice  of  Veter- 
inary Medicine."  New  author's  edition,  entirely 
revised  and  illustrated  with  numerous  plain  and  color- 
ed plates.        By  W.  Williams,  M.R.C.V.S.Svo.,  cloth.     6  00 

(**)WILL1AMS.  "Principles  and  Practice  of  Veter- 
inary Surg-ery."  New  author's  edition,  entirely 
revised  and  illustrated  with  numerous  plain  and 
colored  plates.  By  W.  Williams,  M.R.C.V.S.  8vo, 
cloth 6  00 

ZUNDEL.  "The  Horse's  Foot  and  Its  Diseases."  By 
A.  Ziindel,  Principal  Veterinarian  of  Alsace  Lorraine. 
Translated  by  Dr.  A.  Liautard,  V.S.  12mo,  cloth 
illustrated 2  00 

ZUILL.  "Typhoid  Feyev;  or  Contagious  Influenza 
in  the  Horse."  By  Prof.  W.  L.  Zulll,  M.D.,D.V.S. 
Pamphlet , 25 


Williaia  a.  Jenkins'    Veterinary  Booka. 


VETERINARY    JOURNALS. 

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Edited    by  Prof.  William  Williams,  (Monthly),  per 

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